HAC Healthcare Accounting Billing & Reimbursement 3

Question 1

A provider submits a claim and receives a denial with Claim Adjustment Reason Code (CARC) 29. What is the most likely issue?

Accepted Answer

The claim was not submitted within the required timely filing period

Answer

CARC 29 indicates the claim was denied because it was not submitted within the payer's required timely filing limit.

Question 2

Under the Medicare Outpatient Prospective Payment System (OPPS), payments are determined by which grouping system?

Accepted Answer

Ambulatory Payment Classifications (APCs)

Answer

OPPS uses Ambulatory Payment Classifications (APCs) to bundle and pay for outpatient hospital services.

Question 3

What does the term 'superbill' refer to in a physician's office billing workflow?

Accepted Answer

A document that captures diagnosis and procedure codes for a patient encounter used to generate a claim

Answer

A superbill is an encounter form or charge ticket that lists the diagnosis and procedure codes documented during a patient visit, which is then used to create the billing claim.

Question 4

Which of the following best describes 'coordination of benefits' (COB)?

Accepted Answer

A process that determines the order in which multiple health plans pay a claim to prevent overpayment

Answer

COB is the process used when a patient has more than one insurance policy to determine which plan pays first (primary) and which pays second (secondary) to avoid duplicate payments.

Question 5

In value-based reimbursement, what is a 'shared savings' arrangement?

Accepted Answer

A model where providers and payers share in cost savings achieved when spending falls below a benchmark

Answer

In shared savings models, if total healthcare costs come in below a pre-set benchmark, the provider organization receives a percentage of the savings as a bonus payment.

(HAC) Healthcare Accounting Certification Practice Test

(HAC) Healthcare Accounting Certification Practice Test

HAC Healthcare Accounting Billing & Reimbursement 3