Chapter 28 — Quiz

26 questions. Answers and explanations are in the instructor guide.

1. The transaction that carries the electronic remittance advice is the:

  • A. 837
  • B. 835
  • C. 277
  • D. 270

2. A remittance advice goes to the provider. The document that goes to the patient is the:

  • A. Standard paper remittance
  • B. Explanation of benefits
  • C. 835
  • D. Claim status response

3. Every adjustment on a remittance has three parts:

  • A. A charge, a payment, and a balance
  • B. A group code, a CARC, and an amount
  • C. A CARC, a RARC, and a payment
  • D. A date, a code, and a modifier

4. On every service line:

  • A. Charge equals allowed
  • B. Charge equals paid plus the sum of the adjustments
  • C. Allowed equals paid
  • D. Paid equals allowed minus the charge

5. A group code of CO means:

  • A. The patient owes it
  • B. The provider absorbs it under the contract and may not bill the patient
  • C. A secondary payer owes it
  • D. The payer will reprocess

6. PR-2 reports:

  • A. A deductible
  • B. Coinsurance
  • C. A copay
  • D. A non-covered service

7. OA most commonly reports:

  • A. A contractual adjustment
  • B. Coordination of benefits
  • C. A copay
  • D. A duplicate claim

8. A PR amount posted as CO produces:

  • A. An error message
  • B. Silent revenue loss with no error message
  • C. A patient complaint
  • D. A rejected claim

9. A CO amount posted as PR is worse because:

  • A. It is invisible
  • B. It is a contract violation and possibly a compliance matter
  • C. It reduces the collection rate
  • D. It creates a duplicate

10. CO-45 is:

  • A. A bundling denial
  • B. The contractual adjustment — charge exceeds the contracted amount
  • C. A medical necessity denial
  • D. A timely filing denial

11. CO-97 asserts that:

  • A. The claim is a duplicate
  • B. The benefit for this service is included in the payment for another already adjudicated
  • C. The filing limit expired
  • D. The patient is not covered

12. CO-16 is unactionable by itself because:

  • A. It has no amount
  • B. It says information is missing without saying what — the RARC names it
  • C. It is not a real code
  • D. It applies only to institutional claims

13. RARC N19 states that a procedure code is:

  • A. Invalid
  • B. Incidental to the primary procedure
  • C. A duplicate
  • D. Not covered

14. Posting should be done:

  • A. At the claim level for efficiency
  • B. At the line level
  • C. At the check level
  • D. Only for lines that paid

15. A zero-payment line should be posted because:

  • A. It affects the deposit
  • B. It carries the group code, CARC, and RARC that explain why
  • C. It is required by HIPAA
  • D. It changes the allowed amount

16. A contractual adjustment is:

  • A. A decision to stop pursuing collectible money
  • B. Money that was never collectible under the contract
  • C. Bad debt
  • D. A charity write-off

17. A CO-97 posted as a contractual adjustment produces an account that:

  • A. Ages in the over-90 bucket
  • B. Looks paid in full, with nothing in any denial log or work queue
  • C. Generates a patient statement
  • D. Rejects

18. Autoposting requires:

  • A. Nothing beyond claim submission
  • B. ERA enrollment, which is separate and per payer
  • C. EFT enrollment only
  • D. A paper remittance

19. Which is something autoposting cannot do?

  • A. Post a thousand lines accurately
  • B. Apply payments the day they arrive
  • C. See an underpayment
  • D. Post consistently

20. An underpayment is hard to detect because it:

  • A. Denies
  • B. Rejects
  • C. Arrives as a payment and appears on no exception report
  • D. Produces a takeback

21. A silent underpayment affects the net collection rate by:

  • A. Lowering it
  • B. Raising it, because the denominator shrinks with the numerator
  • C. Leaving it unchanged
  • D. Making it negative

22. The hardest step in underpayment detection is:

  • A. Comparing the amounts
  • B. Building the expected allowed amount per line from the contract
  • C. Setting a threshold
  • D. Reporting the variance

23. A variance can mean the contract is loaded wrong, the claim was wrong, or the payer is wrong. The payer error is important because it is:

  • A. The most common
  • B. Systematic — a configuration applying to every claim of that type since it was made
  • C. Always appealable
  • D. Reported by the payer

24. A remittance shows \$4,812.00 in claim payments and an EFT of \$4,199.60. The correct handling is to:

  • A. Reduce each claim payment proportionally
  • B. Post claims in full and post the offset as a separate provider-level transaction
  • C. Post only the EFT amount
  • D. Reject the remittance

25. A PR balance from a primary payer, when a secondary exists, is:

  • A. The patient's
  • B. Not yet the patient's — the secondary considers it first
  • C. A contractual adjustment
  • D. Written off

26. On Account 10-4471's first remittance, line 1 carries:

  • A. Only CO-97
  • B. CO-45 of \$56.60 and CO-97 of \$128.40
  • C. PR-3 of \$30.00
  • D. No adjustments