NHI Medical Office Procedures & Billing 4

Question 1

A provider who has signed a contract with an insurance company agreeing to accept the payer's fee schedule is called a:

Accepted Answer

Participating provider

Answer

A participating provider has contracted with a payer and agrees to accept the payer's allowed amount as payment in full, minus patient cost-sharing.

Question 2

When a claim is submitted with an incorrect patient date of birth, the claim will most likely be:

Accepted Answer

Denied for eligibility mismatch

Answer

An incorrect date of birth can cause the patient's eligibility to not match payer records, resulting in an eligibility-related denial.

Question 3

The 'filing deadline' in medical billing refers to:

Accepted Answer

The time limit within which a claim must be submitted to a payer

Answer

Each payer sets a timely filing deadline by which claims must be submitted; claims filed after this deadline are typically denied.

Question 4

Which of the following is an example of fraud in medical billing?

Accepted Answer

Intentionally billing for services never rendered to increase reimbursement

Answer

Fraud involves deliberate, intentional acts such as billing for services not performed in order to obtain payment unlawfully.

Question 5

A 'modifier' in CPT coding is used to:

Accepted Answer

Provide additional information about a procedure without changing its definition

Answer

A CPT modifier is a two-digit code appended to a CPT code to indicate special circumstances without altering the procedure's core meaning.

(NHI) National Healthcareer Institute Certification Practice Test