Please select 3 correct answers
Clean claims require accurate demographic and insurance details (A), proper coding (B), and timely submission (C). While patient financial responsibility is communicated to the patient, it is not included on the claim submitted to the payer (D).
Please select 3 correct answers
Common reasons for claim denials include errors in patient information (A), missing prior authorization (B), and incomplete documentation (C). Services covered under a capitated agreement (D) are generally not denied, as they are reimbursed differently.
Please select 3 correct answers
Improving reimbursement involves auditing coding accuracy (A), negotiating effective contracts (B), and ensuring staff are trained on billing and documentation (D). Modifiers (C) are often necessary for accurate claims and should not be avoided indiscriminately.
Please select 3 correct answers
EOBs and RAs provide claim processing details (A), inform the provider of payment or denial decisions (B), and indicate patient responsibility (D). They do not serve as proof of patient payment to the provider (C).
Please select 3 correct answers
Denial management involves tracking trends (A), appealing with complete details (C), and educating staff on how to avoid common mistakes (D). Resubmitting denied claims without corrections (B) is ineffective and may lead to further denials.
