CPB Certified Professional Biller Certification Practice Exam

In the context of health billing, what does the term "claim" refer to?

1. A request for payment from an insurer

2. A policyholder's account balance

3. A provider's contract with a patient

4. A summary of healthcare activities

The correct answer is: A request for payment from an insurer

The term "claim" in health billing specifically refers to a request for payment from an insurer for services provided to a patient. When a healthcare provider delivers services to a patient, they submit a claim to the insurance company to request reimbursement for the costs incurred during treatment. This process is crucial for both the provider to receive payment for their services and for the insurance company to manage and evaluate their financial obligations. The other options discuss different aspects of the healthcare billing system. For instance, a policyholder's account balance pertains to the outstanding amount owed by the patient or the insurance coverage details. A provider's contract with a patient defines the terms of service and payment arrangements but does not constitute a claim. Lastly, a summary of healthcare activities might outline the patient's treatment history but does not serve the same purpose as a claim for payment. Understanding these distinctions is key to navigating the billing process effectively.