Medical Billing Software Medical Billing Software Claims Processing & Denial Management

Question 1

Which claim form is used by most non-institutional providers such as physicians and outpatient clinics when submitting paper claims?

Accepted Answer

CMS-1500

Answer

UB-04

Answer

ADA Dental Claim Form

Answer

HCFA-1450

Question 2

What is a timely filing limit in medical billing?

Accepted Answer

The payer-established deadline by which a claim must be submitted after the date of service

Answer

The deadline for a patient to pay their balance

Answer

The number of days a provider has to appeal a denied claim

Answer

The time allowed between eligibility verification and service delivery

Question 3

What does the acronym EDI stand for in medical billing?

Accepted Answer

Electronic Data Interchange

Answer

Electronic Diagnosis Index

Answer

Eligibility Documentation Interface

Answer

Enhanced Denial Investigation

Question 4

Which HIPAA transaction set is used to submit electronic professional claims to payers?

Accepted Answer

837P

Answer

835

Answer

270/271

Answer

276/277

Question 5

What is the function of modifier -25 in medical billing?

Accepted Answer

Indicates a significant, separately identifiable evaluation and management service was performed on the same day as a procedure

Answer

Indicates a bilateral procedure was performed

Answer

Indicates the service was performed by a physician assistant

Answer

Indicates the claim is being resubmitted after a correction

Question 6

Which denial reason code most commonly indicates that a service is not covered under the patient's current plan?

Accepted Answer

CO-50

Answer

CO-4

Answer

CO-97

Answer

CO-29