Medical Billing Software Medical Billing General 2

Question 1

What does the ERA (Electronic Remittance Advice) document communicate to a provider?

Accepted Answer

Payment details and claim adjudication results from a payer

Answer

An ERA is an electronic transaction from the payer that explains how a claim was adjudicated and details the payment made to the provider.

Question 2

Which modifier should be appended to a CPT code when a procedure is performed bilaterally?

Accepted Answer

-50

Answer

Modifier -50 indicates a procedure was performed bilaterally on both sides of the body during the same operative session.

Question 3

A claim is denied with reason code CO-4. What does this typically indicate?

Accepted Answer

The procedure code is inconsistent with the modifier

Answer

CO-4 indicates the procedure code is inconsistent with the modifier billed, requiring correction before resubmission.

Question 4

What is the primary purpose of a charge master (chargemaster) in a hospital billing system?

Accepted Answer

To list all services, supplies, and their standard charges used for billing

Answer

The chargemaster is a comprehensive list of every billable item a hospital offers along with its standard price, forming the basis of all claims.

Question 5

Under HIPAA, which transaction set is used for electronic health care claim submission?

Accepted Answer

X12 837

Answer

The X12 837 transaction is the HIPAA-mandated standard for submitting electronic health care claims to payers.

Medical Billing Software Practice Test