NHI Medical Office Procedures & Billing 2 — Questions and Answers
Question 1: A patient's insurance claim is denied because the procedure code doesn't match the diagnosis code. This is called a:
- Coordination of benefits error
- Medical necessity denial
- Code linkage error (Correct answer)
- Timely filing denial
Correct answer: Code linkage error
A code linkage error occurs when the diagnosis code does not support or justify the procedure code submitted on the claim.
Question 2: Which form is used to submit professional (non-institutional) medical claims to insurance payers?
- UB-04
- CMS-1450
- CMS-1500 (Correct answer)
- ADA Dental Claim Form
Correct answer: CMS-1500
The CMS-1500 form is the standard paper claim form used by physicians and other non-institutional providers to bill insurance payers.
Question 3: In medical billing, what does the abbreviation 'EOB' stand for?
- Evidence of Benefits
- Explanation of Benefits (Correct answer)
- Estimate of Billing
- End of Benefits
Correct answer: Explanation of Benefits
EOB stands for Explanation of Benefits, a document sent by an insurer to the patient and provider explaining what was covered and paid.
Question 4: A patient schedules an appointment but fails to show up and does not call to cancel. This is documented as a:
- Cancellation
- No-show (Correct answer)
- Walk-in
- Referral
Correct answer: No-show
A no-show is when a patient misses a scheduled appointment without notifying the office in advance.
Question 5: When posting insurance payments, a 'contractual adjustment' represents:
- A patient co-payment amount
- The amount written off per a payer contract (Correct answer)
- A late payment fee
- A refund issued to the patient
Correct answer: The amount written off per a payer contract
A contractual adjustment is the difference between the provider's billed charge and the contracted rate that must be written off.
Question 6: Which of the following best describes 'superbill' in a medical office?
- A large unexpected patient invoice
- A document listing diagnoses and procedures for billing purposes (Correct answer)
- An itemized hospital bill
- A summary of annual revenue
Correct answer: A document listing diagnoses and procedures for billing purposes
A superbill (also called an encounter form) is a comprehensive list of services, diagnoses, and fees used to generate a patient's claim.
Question 7: The process of verifying a patient's insurance coverage before a scheduled appointment is called:
- Pre-authorization
- Eligibility verification (Correct answer)
- Coordination of benefits
- Utilization review
Correct answer: Eligibility verification
Eligibility verification confirms that a patient has active insurance coverage and determines their benefits before the visit.
NHI Medical Office Procedures & Billing 2
A patient's insurance claim is denied because the procedure code doesn't match the diagnosis code.
This is called a: