Medical Billing Software Medical Insurance Billing 2

Question 1

Which claim form is used by hospitals and inpatient facilities for billing insurance?

Accepted Answer

UB-04

Answer

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?

Accepted Answer

The process of determining which insurance plan pays first when a patient has multiple policies

Answer

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?

Accepted Answer

An explanation from the payer detailing claim payment or denial decisions

Answer

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'?

Accepted Answer

A claim that is automatically forwarded from Medicare to Medicaid for secondary payment

Answer

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?

Accepted Answer

The deadline imposed by an insurer within which a claim must be submitted after the date of service

Answer

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.

Medical Billing Software Practice Test

Medical Billing Software Practice Test

Medical Billing Software Medical Insurance Billing 2