NHI Medical Office Procedures & Billing 2

Question 1

A patient's insurance claim is denied because the procedure code doesn't match the diagnosis code. This is called a:

Accepted Answer

Code linkage error

Answer

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?

Accepted Answer

CMS-1500

Answer

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?

Accepted Answer

Explanation of Benefits

Answer

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:

Accepted Answer

No-show

Answer

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:

Accepted Answer

The amount written off per a payer contract

Answer

A contractual adjustment is the difference between the provider's billed charge and the contracted rate that must be written off.

(NHI) National Healthcareer Institute Certification Practice Test