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

The CMS-1500 claim form is the standard paper claim form used by physicians and non-institutional providers to bill Medicare Part B and most commercial insurers.

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

Coordination of benefits (COB) determines the order in which multiple health insurance plans pay claims so that total payments do not exceed 100% of the 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 clean claim is one that contains all required information and can be processed for payment without additional follow-up or information from the provider.

Question 4

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

Accepted Answer

Medicare Fee Schedule amount

Answer

The Medicare Fee Schedule amount (approved amount) is the maximum amount Medicare will pay for a covered service based on the Medicare Physician Fee Schedule.

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

Medicare Part B claims must be filed within one calendar year (12 months) from the date of service to be considered timely.

(CPC) Certified Procedural Coder Practice Test

(CPC) Certified Procedural Coder Practice Test

CPC Reimbursement & Claims Processing