Which of the following could lead to a claim being denied?

Prepare for the Certified Billing and Coding Specialist Exam. Improve your skills with multiple choice questions; each question comes with hints and explanations. Get confident for your exam!

An invalid subscriber name provided is a significant reason for a claim being denied. When submitting a health insurance claim, the insurance company requires accurate information to process the claim correctly. The subscriber's name must match the records held by the insurance provider. An invalid subscriber name can lead to confusion or the inability for the insurance company to locate the correct account, resulting in a denial of the claim. Proper identification is essential for the verification of benefits and eligibility, and without it, the claim cannot be processed.

The other scenarios do not inherently cause a claim to be denied. The absence of a patient encounter could affect billing, but it needs to be assessed in context; valid coding, by definition, should align with services rendered, and affirmative approval from patients typically indicates that they consented to receive the services billed. Therefore, these would not typically lead to a claim being denied as they represent standard practices in healthcare billing.

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