AAPC Claims Management & Adjudication 1

Question 1

What is the first step in the claims adjudication process?

Accepted Answer

Verifying patient eligibility and benefits

Answer

Appealing a denied claim

Answer

Submitting a corrected claim

Answer

Billing the patient directly

Question 2

Which document outlines the insurance company's payment decision?

Accepted Answer

Explanation of Benefits (EOB)

Answer

CMS-1500 Form

Answer

Patient ledger

Answer

Charge master

Question 3

What happens if a claim is submitted with missing information?

Accepted Answer

It is denied or rejected for missing information

Answer

It is automatically approved.

Answer

It is paid at a reduced rate.

Answer

It is forwarded to collections.

Question 4

What is coordination of benefits (COB)?

Accepted Answer

Determining which insurer pays first

Answer

Paying claims twice

Answer

Rejecting all claims

Answer

Collecting payments directly from patients

Question 5

What does the term 'clean claim' mean?

Accepted Answer

A claim submitted without errors or omissions

Answer

A claim filed by a preferred provider

Answer

A claim that requires multiple appeals

Answer

A claim that is automatically denied

Question 6

What is the purpose of claim appeals?

Accepted Answer

To challenge a denied or underpaid claim

Answer

To request a refund

Answer

To correct billing codes

Answer

To cancel patient coverage

Question 7

What is a denial code?

Accepted Answer

A code identifying reasons for claim denial

Answer

A code indicating a payment has been processed

Answer

A code showing claim approval

Answer

A code for patient billing purposes

Question 8

What is the timely filing limit for insurance claims?

Accepted Answer

Typically 90 days to one year after service

Answer

There is no time limit.

Answer

Five years after the service date

Answer

Only after an appeal is filed

Question 9

Why is accurate coding important for claims adjudication?

Accepted Answer

It speeds up the claim payment and prevents denials

Answer

It creates confusion for payers

Answer

It guarantees automatic approval

Answer

It lowers reimbursement rates