Reimbursements and Collections| CPC Exam Review 2025|Test Questions and Answers
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CPC Certified Professional Coder
Reimbursements and Collections| CPC
Exam Review 2025|Test Questions and
Answers
RBRVS The resource-based relative value scale (RBRVS) is the physician payment system
used by the Centers for Medicare & Medicaid Services ( CMS ) and most other payers.
Provider credentialing Credentialing is t...
Reimbursements and Collections| CPC
Exam Review 2025|Test Questions and
Answers
RBRVS The resource-based relative value scale (RBRVS) is the physician payment system
used by the Centers for Medicare & Medicaid Services ( CMS ) and most other payers.
Provider credentialing Credentialing is the process of obtaining and reviewing documentation
to determine participation status in a health plan.
What is the primary purpose of the reimbursement process in healthcare? The primary
purpose of the reimbursement process is to ensure that healthcare providers are paid for the
services rendered to patients.
What is the difference between a fee-for-service and a bundled payment reimbursement model?
A fee-for-service model pays healthcare providers for each individual service provided, while
a bundled payment model pays a single fee for a group of related services.
What is a clean claim? A clean claim is a claim that is submitted with all necessary
information and is free of errors, allowing it to be processed without delay.
What is a denied claim? A denied claim is a claim that is rejected by the insurance company
due to issues such as incorrect coding, lack of coverage, or missing documentation.
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, What is the purpose of medical coding in the reimbursement process? Medical coding is used
to translate healthcare services and diagnoses into standardized codes, which are required for
insurance claims to be processed and reimbursed.
What is the difference between primary and secondary insurance? Primary insurance is the
first insurance policy that pays for healthcare services, while secondary insurance may cover
additional costs after the primary insurance has paid its portion.
What is the role of a clearinghouse in the claims process? A clearinghouse is an intermediary
that reviews, validates, and transmits claims between healthcare providers and insurance
companies to ensure compliance with the necessary standards.
What is the purpose of an Explanation of Benefits (EOB)? An Explanation of Benefits (EOB)
provides a detailed statement from the insurance company to the patient, outlining the services
covered, the amount reimbursed, and any patient responsibilities.
What does it mean when a claim is "scrubbed"? When a claim is "scrubbed," it means that it
is reviewed for errors and inconsistencies before being submitted to the payer to ensure it is
accurate and complete.
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