CPC Reimbursement & Claims Processing

Question 1

Which claim form is used by physicians and outpatient facilities to bill Medicare Part B?

Accepted Answer

CMS-1500

Answer

UB-04 (CMS-1450)

Answer

ADA Dental Claim Form

Answer

ANSI X12 837P

Question 2

What does the term 'coordination of benefits' (COB) mean in health insurance?

Accepted Answer

A process to determine which payer pays first when a patient has multiple insurance plans

Answer

A process for calculating patient deductibles

Answer

The method used to calculate provider reimbursement rates

Answer

The process of appealing a denied claim

Question 3

What is a 'clean claim' in medical billing?

Accepted Answer

A claim submitted without errors that can be processed and paid without additional information

Answer

A claim with no diagnosis codes

Answer

A claim for preventive services only

Answer

A claim that has been scrubbed of duplicate charges

Question 4

Which Medicare term describes the amount Medicare has approved for a covered service?

Accepted Answer

Medicare Fee Schedule amount

Answer

Allowed amount

Answer

Charge amount

Answer

Cost-sharing amount

Question 5

What is the timely filing deadline for Medicare Part B claims?

Accepted Answer

One year (12 months) from the date of service

Answer

90 days from the date of service

Answer

180 days from the date of service

Answer

Two years from the date of service

Question 6

A patient's insurance pays 80% of allowed charges after the deductible is met. The remaining 20% is called the:

Accepted Answer

Coinsurance

Answer

Premium

Answer

Deductible

Answer

Copayment