Reimbursement and Billing Flashcards
6 cards from real COBGC practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 Reimbursement and Billing flashcards as text
What is the fee schedule used for Medicare OB/GYN reimbursement?
Answer: The Medicare Physician Fee Schedule based on the Resource-Based Relative Value Scale (RBRVS)
Medicare uses the RBRVS system to assign relative values to services based on work, practice expense, and malpractice cost.
What is a clean claim?
Answer: A claim submitted with all required information, correctly coded, and free of errors
Clean claims process faster because they contain all necessary information and have no errors requiring correction.
What is the timely filing deadline?
Answer: The maximum time after the date of service within which a claim must be submitted to the payer
Each payer sets timely filing deadlines; missing them can result in claim denial regardless of whether services were properly rendered.
What is a remittance advice?
Answer: A document from the payer explaining how a claim was processed, including payments and adjustments
The remittance advice (ERA/EOB) details what was billed, allowed, paid, adjusted, and what the patient owes.
What is the difference between participating and non-participating providers?
Answer: Participating providers accept the payer's fee schedule; non-participating providers may charge higher rates
Participating providers agree to accept the payer's allowed amount as payment in full, while non-participating providers may balance bill patients.
What is coordination of benefits?
Answer: The process determining which insurance pays first when a patient has multiple coverage
COB rules determine primary and secondary payer responsibility when patients have coverage from multiple insurance sources.