Medical Billing Software Medical Billing Software Claims Processing & Denial Management 1

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

The CMS-1500 is the standard paper claim form used by physicians, non-institutional providers, and outpatient facilities to bill Medicare, Medicaid, and most commercial insurers.

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

Timely filing limits are payer-specific deadlines that require claims to be submitted within a set period after the date of service, or the claim will be automatically denied.

Question 3

What does the acronym EDI stand for in medical billing?

Accepted Answer

Electronic Data Interchange

Answer

EDI (Electronic Data Interchange) is the standardized electronic format used to transmit healthcare claims, remittances, and eligibility transactions between providers and payers.

Question 4

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

Accepted Answer

837P

Answer

The 837P transaction set is the HIPAA-mandated electronic format for submitting professional (physician) claims to payers.

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

Modifier -25 is appended to an E/M code to indicate that a significant, separately identifiable evaluation and management service was rendered by the same physician on the same day as another procedure.

Medical Billing Software Practice Test

Medical Billing Software Practice Test

Medical Billing Software Medical Billing Software Claims Processing & Denial Management 1