Which term describes the amount that is adjusted after processing a claim to reflect payer edits or contractual adjustments?

Which term describes the amount that is adjusted after processing a claim to reflect payer edits or contractual adjustments?

• A. Adjustment
• B. Deductible
• C. Copayment
• D. Coinsurance

Answer: (A)

The amount described is the adjustment that occurs after processing. When a claim is processed, payer edits or negotiated contractual rates can lower the amount the payer will reimburse. This difference between what was billed and what the payer allows is posted as an adjustment — often called a contractual adjustment or write-off — and it reduces the amount the provider can collect. It’s separate from patient cost-sharing, which is described by deductible (amount the patient pays before the insurer covers), copayment (a fixed fee at the time of service), and coinsurance (a percentage of charges after any deductible is met).

The amount described is the adjustment that occurs after processing. When a claim is processed, payer edits or negotiated contractual rates can lower the amount the payer will reimburse. This difference between what was billed and what the payer allows is posted as an adjustment — often called a contractual adjustment or write-off — and it reduces the amount the provider can collect. It’s separate from patient cost-sharing, which is described by deductible (amount the patient pays before the insurer covers), copayment (a fixed fee at the time of service), and coinsurance (a percentage of charges after any deductible is met).