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CBCS
PAYMENT ADJUDICATION
| Question | Answer |
|---|---|
| A billing and coding specialist receives an explanation of benefits from an insurance carrier for an office visit with a cost of $120. The provider participates in the patient’s insurance plan, the patient has a remaining deductible of $52, and the | $54.40 |
| A patient’s claim is denied, stating that the diagnosis code does not meet requirements for procedure or service. Which of the following is the next step in obtaining reimbursement? | file an appeal |
| A patient in a prepaid group plan is charged $80 for an office visit. After the patient pays the $10 copay, which of the following amounts should the billing and coding specialist adjust off the account? | $70 |
| The balances listed on an insurance aging report represent which of the following | Outstanding amounts owed to the practice |
| A patient’s payment is considered uncollectable. A billing and coding specialist should record an entry on the patient ledger as which of the following types of bad debt? | Write off |
| A billing and coding specialist should use which of the following to determine if claims are delinquent? | Aging Report |
| To ensure all claims are being submitted and received, a billing and coding specialist should document all claims processing on which of the following? | An insurance claims register |
| A patient has a coinsurance of 10%, a $20 copayment, and has met his annual deductible. If the contracted rate for the office visit is $200, what is the total out of pocket fee for this patient? | $40 |
| Which of the following information is contained in a remittance advice? | Payment determination for a claim |
Created by:
nareeman89000