FREE CBCS Reimbursement Questions and Answers

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Which factor does NOT typically influence reimbursement rates in a fee-for-service (FFS) model?

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In the fee-for-service model, reimbursement rates are generally influenced by factors such as the type of service or procedure, geographic location, and complexity of the service, but not the provider’s relationship with the patient.

What is the purpose of a "remittance advice" in medical billing?

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Remittance advice is a document sent by the insurance company to the healthcare provider detailing the payment made or explaining the reasons for claim denial. It provides the provider with information on how claims were processed and paid.

Which of the following is a common reason for claim denial in medical billing?

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Claims can be denied for various reasons, including the expiration of the patient’s insurance policy. Denials typically occur due to issues such as policy expiration, incorrect patient information, or billing for services that are not covered under the current policy.

When an insurance claim is denied, what is the first step in managing Accounts Receivable (AR)?

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The first step when managing a denied claim is to review the denial reason and correct any errors before resubmitting. This helps to address the issue that led to the denial and improves the chances of successful payment on resubmission.

Which form is also known as the CMS-1450?

Correct! Wrong!

The CMS-1450 form is also known as the UB-04. It is used for billing hospital inpatient and outpatient services to insurance companies.

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