CPCA CPCA Reimbursement and Payer Policies 2

Question 1

What form is used to submit professional claims to Medicare and most commercial payers?

Accepted Answer

CMS-1500

Answer

UB-04

Answer

CMS-1450

Answer

ADA Dental Claim Form

Question 2

A patient has both Medicare Part B and a Medigap policy. Which payer receives the claim first?

Accepted Answer

Medicare Part B

Answer

Medigap

Answer

Medicaid

Answer

The patient pays first

Question 3

What does the term 'coordination of benefits' (COB) refer to in medical billing?

Accepted Answer

Determining which payer is primary when a patient has multiple coverages

Answer

Calculating the patient's deductible

Answer

Verifying provider credentials with insurance companies

Answer

Submitting claims electronically

Question 4

Which modifier is appended to a CPT code to indicate that a service was reduced or eliminated at the physician's discretion?

Accepted Answer

Modifier 52

Answer

Modifier 25

Answer

Modifier 59

Answer

Modifier 51

Question 5

A practice receives a denial code CO-4. What does this typically indicate?

Accepted Answer

Modifier is inconsistent with the procedure code

Answer

Service not covered by the plan

Answer

Duplicate claim submitted

Answer

Patient is not eligible

Question 6

What is the timely filing limit for most commercial insurance claims if not otherwise specified?

Accepted Answer

1 year from date of service

Answer

30 days from date of service

Answer

90 days from date of service

Answer

6 months from date of service