MB 400 WEEK 2 EXAM UPDATED ACTUAL QUESTIONS
AND CORRECT ANSWERS
Question:
1. Which of the following will occur if a claim does not fall within the normal guidelines?
Answer:
It will be denied.
Question:
2. Which of the following is an example of an error relating to the coding process that will result in a
denial of payment?
Answer:
a mismatch between gender or age of the patient and the selected code.
Question:
3. What is one of the most effective methods of reducing the number of denials received by a facility?
Answer:
understand types and categories.
Question:
4. How can a provider prevent a claim from being denied for missing information?
Answer:
follow the insurer's unique requirements every time.
Question:
5. How can a provider protect itself from a loss of revenue when services are not considered covered in its
contracts?
Answer:
have patients sign an advance beneficiary notice.
Question:
6. Which type of denial is likely to occur if a provider does not file a claim within a specific time period?
Answer:
contractual obligation.
Question:
7. Why is it important for a provider to pay attention to CARCs and RAR- Cs when there is a denial of
payment?
Answer:
to identify trends and the dollar value of denials.
Question:
8. How can using advanced data tools of analytics predict and prevent denials?
Answer:
Providers can review and fix outliers earlier.
,Question:
9. How can health care organizations develop a more comprehensive and systematic approach to
identifying root causes and trends in denials?
Answer:
use of analytics.
Question:
10. Where would a provider find information on why a line item on a claim was paid differently than it was
billed?
Answer:
CARCs.
Question:
11. How are appeals used by health care providers?
Answer:
to challenge the payer's decision.
Question:
12. Before determining whether or not to appeal a denial, what should be considered on a case-by-case
basis?
Answer:
whether the reimbursement difference is worth an appeal
Question:
13. When pursuing a coding appeal, what should be included in the appeal?
Answer:
documentation that supports the DRG billed.
Question:
14. When using the IRAC process to decrease denials, in which aspect of the process should you clearly
identify the reason for the denial and address it?
Answer:
Issue.
Question:
15. What advantage is there in using a software program in the appeals process?
Answer:
All relevant information is stored in one place.
Question:
16. When writing an appeals letter, what should the billing department include when appealing the denial?
Answer:
documentation to substantiate the appeal.
Question:
17. When a provider does not comply with a request for additional documentation in a timely manner, such
as a discharge summary or lab report, which type of denial is likely to occur?
, Answer:
missing records.
Question:
18. Which of the following indicates the difference between denials based on medical necessity and
clinical validation?
Answer:
Denials based on medical necessity include a service that does not match the diagnosis.
Question:
19. Which type of appeal would be appropriate if the insurance company claims the procedure performed
was not necessary and denied the claim?
Answer:
medical.
Question:
20. When is a billing error related to coding linkage likely to occur?
Answer:
when reported services are not consistent with the diagnosis.
Question:
21. Why is the process of root cause analysis a good tool for a denials management program?
Answer:
It helps in understanding where denials originate.
Question:
22. Your facility has received an unusual number of claims denials. How can you determine why the
denials are happening and develop a systematic approach to reducing denial rates?
Answer:
use analytics to identify root causes and trends.
Question:
23. A patient with a broken bone receives an x-ray. The claim is denied. The supervisor reviews the denied
claim and finds that it was submitted by an individual whose similar claims have all been denied for not
using the current codes. Based on this scenario, what do you propose doing to correct the issue?
Answer:
provide education and training.
Question:
24. When would a claim be denied based on missing information rather than missing records?
Answer:
Information the insurer wants to see is lacking.
Question:
25. When would a claim denial be based on clinical validation rather than medical necessity?
Answer:
when a coded diagnosis is lacking clinical evidence.
AND CORRECT ANSWERS
Question:
1. Which of the following will occur if a claim does not fall within the normal guidelines?
Answer:
It will be denied.
Question:
2. Which of the following is an example of an error relating to the coding process that will result in a
denial of payment?
Answer:
a mismatch between gender or age of the patient and the selected code.
Question:
3. What is one of the most effective methods of reducing the number of denials received by a facility?
Answer:
understand types and categories.
Question:
4. How can a provider prevent a claim from being denied for missing information?
Answer:
follow the insurer's unique requirements every time.
Question:
5. How can a provider protect itself from a loss of revenue when services are not considered covered in its
contracts?
Answer:
have patients sign an advance beneficiary notice.
Question:
6. Which type of denial is likely to occur if a provider does not file a claim within a specific time period?
Answer:
contractual obligation.
Question:
7. Why is it important for a provider to pay attention to CARCs and RAR- Cs when there is a denial of
payment?
Answer:
to identify trends and the dollar value of denials.
Question:
8. How can using advanced data tools of analytics predict and prevent denials?
Answer:
Providers can review and fix outliers earlier.
,Question:
9. How can health care organizations develop a more comprehensive and systematic approach to
identifying root causes and trends in denials?
Answer:
use of analytics.
Question:
10. Where would a provider find information on why a line item on a claim was paid differently than it was
billed?
Answer:
CARCs.
Question:
11. How are appeals used by health care providers?
Answer:
to challenge the payer's decision.
Question:
12. Before determining whether or not to appeal a denial, what should be considered on a case-by-case
basis?
Answer:
whether the reimbursement difference is worth an appeal
Question:
13. When pursuing a coding appeal, what should be included in the appeal?
Answer:
documentation that supports the DRG billed.
Question:
14. When using the IRAC process to decrease denials, in which aspect of the process should you clearly
identify the reason for the denial and address it?
Answer:
Issue.
Question:
15. What advantage is there in using a software program in the appeals process?
Answer:
All relevant information is stored in one place.
Question:
16. When writing an appeals letter, what should the billing department include when appealing the denial?
Answer:
documentation to substantiate the appeal.
Question:
17. When a provider does not comply with a request for additional documentation in a timely manner, such
as a discharge summary or lab report, which type of denial is likely to occur?
, Answer:
missing records.
Question:
18. Which of the following indicates the difference between denials based on medical necessity and
clinical validation?
Answer:
Denials based on medical necessity include a service that does not match the diagnosis.
Question:
19. Which type of appeal would be appropriate if the insurance company claims the procedure performed
was not necessary and denied the claim?
Answer:
medical.
Question:
20. When is a billing error related to coding linkage likely to occur?
Answer:
when reported services are not consistent with the diagnosis.
Question:
21. Why is the process of root cause analysis a good tool for a denials management program?
Answer:
It helps in understanding where denials originate.
Question:
22. Your facility has received an unusual number of claims denials. How can you determine why the
denials are happening and develop a systematic approach to reducing denial rates?
Answer:
use analytics to identify root causes and trends.
Question:
23. A patient with a broken bone receives an x-ray. The claim is denied. The supervisor reviews the denied
claim and finds that it was submitted by an individual whose similar claims have all been denied for not
using the current codes. Based on this scenario, what do you propose doing to correct the issue?
Answer:
provide education and training.
Question:
24. When would a claim be denied based on missing information rather than missing records?
Answer:
Information the insurer wants to see is lacking.
Question:
25. When would a claim denial be based on clinical validation rather than medical necessity?
Answer:
when a coded diagnosis is lacking clinical evidence.
