Certified Medical Assistant Practice Exam

What will happen to an insurance claim if the coding is incorrectly entered on the insurance form?

1. The claim will be accepted without issues

2. The claim will be put on hold for further review

3. The claim will be denied, and the physician will not receive payment

4. The claim will be automatically corrected

The correct answer is: The claim will be denied, and the physician will not receive payment

When coding is incorrectly entered on an insurance form, the most likely outcome is denial of the claim, resulting in the physician not receiving payment. Insurance companies rely on precise coding to determine the appropriateness of the care provided and to process reimbursements. Incorrect codes can lead to misunderstandings about the service rendered, causing insurers to deny the claim altogether. An incorrect code may suggest that the procedure was not covered, the diagnosis wasn’t valid for the service, or any other issue that could affect the payment. This reinforces the importance of accurate coding in the billing process, as errors can lead to financial losses for healthcare providers. Submitting a claim with correct information is essential not only for timely payment but also for maintaining a good relationship with both patients and insurance companies. Therefore, ensuring that coding is accurate is a critical responsibility for medical assistants involved in the billing process. The scenario described in the question highlights the need for diligence when entering codes, as even a small error can have significant consequences on claim approval.