What is the purpose of the CMS-1500 form?
The CMS-1500 form is used by healthcare providers to bill Medicare and other health insurance programs for services rendered.
Which part of Medicare covers outpatient services?
Medicare Part B covers outpatient services, such as doctor visits, preventive services, and medical supplies.
What is the main purpose of a remittance advice (RA)?
A remittance advice provides information about claim payments, denials, and adjustments from a payer to a provider.
What is a deductible in health insurance?
A deductible is the amount a patient must pay out of pocket before insurance begins to pay for services.
Which of the following is a common reason for claim denial?
Incorrect patient information, such as name or ID number, is a frequent reason for claim rejections or denials.
What is coordination of benefits (COB)?
Coordination of benefits ensures that claims are paid correctly when a patient is covered by more than one insurance plan.
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What is the purpose of the Explanation of Benefits (EOB)?
The EOB explains to patients how their insurance claim was processed and the amounts paid and owed.
Which code set is primarily used for reporting procedures and services?
CPT (Current Procedural Terminology) codes are used to describe medical, surgical, and diagnostic services.
What action should be taken if a claim is denied?
If a claim is denied, the provider should review the denial reason, correct any errors, and submit an appeal if necessary.