CPB (Certified Professional Biller) Certification Practice Exam

What does an "Adjusted Claim" imply in medical billing?

1. The appearance of a pathologic condition due to a chemical substance

2. Process that assists providers in collecting appropriate reimbursement

3. Payment correction resulting in additional payment(s) to the provider

4. Document that acknowledges patient responsibility for payment

The correct answer is: Payment correction resulting in additional payment(s) to the provider

An "Adjusted Claim" in medical billing refers to a payment correction that results in additional payment(s) to the provider. This process typically occurs when there has been a revision to the original claim, such as updates to the billed services, adjustments based on negotiations with payers, or corrections due to billing errors. When an adjustment is made, it often reflects a change that increases the amount reimbursed to the provider, ensuring they receive the correct payment for the services rendered. The other options, while related to concepts in medical billing, do not specifically define what an adjusted claim entails. For example, the process of assisting providers in collecting appropriate reimbursement represents broader billing practices but does not specifically focus on claims that have been adjusted. Similarly, acknowledging patient responsibility for payment focuses on patient obligations rather than the intricacies of claim adjustments. The appearance of a pathologic condition due to a chemical substance relates to medical diagnoses rather than billing practices.