CRCR CRCR - Certified Revenue Cycle Representative Program Claims Processing and Billing 2

Question 1

What is the standard electronic claim format used for professional physician billing to Medicare?

Accepted Answer

CMS-1500 transmitted as 837P

Answer

UB-04 transmitted as 837I

Answer

ADA Dental Claim Form

Answer

ANSI X12 271

Question 2

What information is captured in the place of service code on a CMS-1500 claim?

Accepted Answer

The setting where the service was rendered such as office or outpatient hospital

Answer

The patient's home address

Answer

The billing provider's tax ID

Answer

The type of insurance plan the patient has

Question 3

Which position on a claim form identifies the diagnosis primarily responsible for the patient visit?

Accepted Answer

The principal diagnosis code in the first position

Answer

Field 24E diagnosis pointer

Answer

Field 11 insured policy number

Answer

The admitting diagnosis code

Question 4

What is the purpose of a clean claim standard in healthcare billing?

Accepted Answer

To define the minimum data elements required for a claim to be processed without additional information

Answer

To ensure all claims are submitted on paper forms

Answer

To mandate that claims be submitted within 24 hours of service

Answer

To require that all claims include a patient signature

Question 5

A claim is submitted electronically and the practice receives a 277CA transaction. What does this indicate?

Accepted Answer

The claim acknowledgment status showing whether it was accepted or rejected by the payer

Answer

The claim has been paid

Answer

The patient's eligibility has been confirmed

Answer

A request for additional clinical documentation

Question 6

What is coordination of benefits in claims processing?

Accepted Answer

The process of determining the order in which multiple insurance plans pay on a claim

Answer

The process of confirming a patient's primary care physician

Answer

Verifying that the rendering provider is in-network

Answer

Calculating the patient's deductible balance