CPB CHAPTER 9 STUDY GUIDE
SOLUTIONS
Fee schedule - answer-a list of fees physicians establish as the fair price for the services they provide.
Data entry - answer-used for: demographic information, cpt, hcpcs level ii, and icd - 10 - cm codes to
report the services for that encounter, payments ...
Submit claims electronically - answer✔✔-reduces clerical paperwork, cost of postage, envelopes, and
forms. Supplies the practice with reports indicating claims were received, and either accepted or
rejected.
(reduce payment delay)
Check status reports - answer✔✔-are reports sent from the payers identifying the status of the claims
that were received. The report will identify each claim with the patients' names and date(s) of service
and whether the claims were accepted or rejected by the payer.
(reduce payment delay)
Post contractual adjustments - answer✔✔-a contractual adjustment is the amount the provider agrees
to accept as a participating provider with the insurance carrier.
Prior authorization - answer✔✔-a requirement that a physician obtains approval from a health plan to
perform a specific service/procedure or prescribe a specific medication. Without this prior approval, the
health plan may not provide coverage, or pay for the service/procedure or medication.
Claim scrubbers - answer✔✔-a software program that reviews claims for key components before the
claims are sent to an insurance company. Will identify possible errors before the claim is submitted.
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