CPB Certified Professional Biller Certification Practice Exam

What does an "adjusted claim" indicate in medical billing?

1. A claim that is suspended for review

2. A payment correction leading to additional payments

3. A claim that has been denied initially

4. A claim that requires patient re-approval

The correct answer is: A payment correction leading to additional payments

An "adjusted claim" refers to a payment correction that leads to additional payments. In medical billing, this adjustment usually occurs when corrections are made to the original claim to reflect changes such as updated codes, modifiers, or any inaccuracies that were identified after the claim submission. These adjustments can be made to ensure that the insurance company reimburses the healthcare provider accurately based on the corrected information. When a claim is adjusted, it often means that the billing department has identified an error or issue that could affect the amount that the provider is paid. This could result from an initial underpayment or the discovery of additional services rendered that were not included in the original claim. By submitting an adjusted claim, the provider communicates these changes to the payer in hopes of receiving the appropriate reimbursement. This process is an essential part of medical billing, as it helps maintain financial accuracy and ensures that providers are compensated fairly for the services they deliver.