HAC Healthcare Insurance & Claims Processing 3

Question 1

A provider writes off the difference between their billed charge and the payer-contracted rate. This write-off is called a:

Accepted Answer

Contractual adjustment

Answer

A contractual adjustment reflects the difference between the provider's billed charge and the negotiated contracted rate the provider has agreed to accept.

Question 2

Which Medicare Part covers inpatient hospital stays, skilled nursing facility care, and hospice?

Accepted Answer

Medicare Part A

Answer

Medicare Part A is the hospital insurance component that covers inpatient hospital care, skilled nursing facilities, hospice, and some home health services.

Question 3

Under HIPAA, the standard code set for outpatient physician services and procedures is:

Accepted Answer

CPT/HCPCS Level I and II

Answer

HIPAA mandates the use of CPT (Current Procedural Terminology) and HCPCS Level II codes for reporting outpatient and physician services on professional claims.

Question 4

What is the purpose of an Advance Beneficiary Notice (ABN) in Medicare billing?

Accepted Answer

To inform a Medicare patient that a service may not be covered and obtain their agreement to pay

Answer

An ABN is issued to a Medicare patient before a non-covered or potentially denied service, allowing the provider to collect payment from the patient if Medicare denies the claim.

Question 5

A claim submitted more than 365 days after the date of service is denied by a commercial payer. This denial is categorized as:

Accepted Answer

Timely filing denial

Answer

Timely filing denials occur when claims are submitted after the payer's deadline, which is typically defined in the provider's contract and can range from 90 days to 2 years.

(HAC) Healthcare Accounting Certification Practice Test

(HAC) Healthcare Accounting Certification Practice Test

HAC Healthcare Insurance & Claims Processing 3