Certified Revenue Cycle Representative (CRCR) Practice Exam

What will cause a CMS 1500 claim to be rejected?

1. The provider is billing with a future date of service

2. The claim is missing the patient's signature

3. The procedure code does not match the diagnosis

4. The claim is submitted without proper documentation

The correct answer is: The provider is billing with a future date of service

Billing a CMS 1500 claim with a future date of service is a valid reason for the claim to be rejected. Insurance companies require that the dates of service on the claim reflect services that have already been rendered. If a claim is submitted with a date that is in the future, it suggests that the services have not yet occurred, and therefore, the insurance payer cannot process the claim for payment. Payers rely on accurate dates of service to determine the appropriateness and eligibility for coverage. Regarding the other options, while missing the patient's signature, mismatched procedure and diagnosis codes, and lack of proper documentation may also lead to claim denials, they do not specifically pertain to issues with the date of service itself. Each of those scenarios would follow different protocols for resolution but does not pertain to a future service date.