Medical Billing Software Medical Insurance Billing 2 — Questions and Answers
Question 1: Which claim form is used by hospitals and inpatient facilities for billing insurance?
- CMS-1500
- UB-04 (Correct answer)
- ADA Dental Claim Form
- CMS-1450
Correct answer: UB-04
The UB-04 (also called CMS-1450) is the standard claim form used by institutional providers such as hospitals for inpatient and outpatient billing.
Question 2: What does the term 'coordination of benefits' (COB) mean in medical billing?
- Submitting claims to multiple clearinghouses simultaneously
- The process of determining which insurance plan pays first when a patient has multiple policies (Correct answer)
- Coordinating benefit payments between provider and patient
- Combining medical and dental benefits under one plan
Correct answer: The process of determining which insurance plan pays first when a patient has multiple policies
COB is the process used when a patient has more than one health insurance plan to determine the order in which each plan pays its portion of a claim.
Question 3: What is a 'remittance advice' (RA) in medical billing?
- A patient's statement of benefits used for appeals
- An explanation from the payer detailing claim payment or denial decisions (Correct answer)
- A referral document sent to specialists
- A billing code lookup guide provided by payers
Correct answer: An explanation from the payer detailing claim payment or denial decisions
A remittance advice is a document sent by an insurance company to a provider explaining how claims were processed, including amounts paid, adjusted, or denied.
Question 4: In the context of medical billing, what is a 'crossover claim'?
- A claim submitted to both a commercial insurer and Medicaid on the same day
- A claim that is automatically forwarded from Medicare to Medicaid for secondary payment (Correct answer)
- A claim filed in multiple states simultaneously
- A claim that crosses fiscal year billing periods
Correct answer: A claim that is automatically forwarded from Medicare to Medicaid for secondary payment
A crossover claim is one that is automatically sent from Medicare (primary) to Medicaid (secondary) for patients who are dual-eligible for both programs.
Question 5: What does 'timely filing' refer to in medical billing?
- Submitting claims before the patient's deductible resets
- The deadline imposed by an insurer within which a claim must be submitted after the date of service (Correct answer)
- Filing taxes related to medical practice revenue
- The timeframe for patients to pay their balance
Correct answer: The deadline imposed by an insurer within which a claim must be submitted after the date of service
Timely filing refers to the specific deadline set by each payer within which a provider must submit a claim; missing this deadline typically results in a denial.
Question 6: Which modifier would be appended to a CPT code to indicate a bilateral procedure?
- -50 (Correct answer)
- -51
- -52
- -59
Correct answer: -50
Modifier -50 is used to indicate that an identical procedure was performed on both sides of the body during the same operative session.
Question 7: What is the purpose of a 'prior authorization' in medical billing?
- Retroactive approval of services already rendered
- Advance approval from an insurer required before certain services are provided (Correct answer)
- A patient's pre-authorization to release medical records
- Authorization to bill above the fee schedule
Correct answer: Advance approval from an insurer required before certain services are provided
Prior authorization is approval obtained from an insurance plan before a patient receives specific medical services, medications, or equipment to ensure coverage.
Medical Billing Software Medical Insurance Billing 2
Which claim form is used by hospitals and inpatient facilities for billing insurance?