Chapter 13 Multiple Choice
What type of codes explain Medicare payment decisions?
MOA
If a patient has secondary insurance under a spouse's plan, what information is needed before transmitting a claim to the secondary plan?
RA data
1. RA 2. EOB 3. MSP 4. EFT
RA: Remittance Advice MSP: Medicare Secondary Payer EOB: Explanation of Benefits EFT: Electronic Funds Transfer
A payer's initial processing of a claim screens for
basic errors in claim data or missing information
What is the next step after the primary payer's RA has been posted when a patient has additional insurance coverage?
billing the second payer
Payers should comply with the required
claim turnaround time
Some automated edits are for
patient eligibility, duplicate claims, and noncovered services
Which of the following appears only on secondary claims?
primary payer payment
Determine what should be verified after an RA has been checked for the patient's name, account number, insurance number, and date of service.
that all billed CPT codes are listed
A claim may be downcoded because
the documentation does not justify the level of service
Appeals must always be filed
within a specified time
