Medical Coding and Billing Flashcards
7 cards from real AAMA practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Medical Coding and Billing flashcards as text
A patient's insurance denied a claim stating 'not medically necessary.' What is the coder's BEST first step?
Answer: Review the documentation and verify correct diagnosis codes support medical necessity
The coder should first review the clinical documentation and diagnosis codes to confirm they accurately reflect the medical necessity before filing an appeal.
Which of the following is an example of unbundling?
Answer: Billing each component of a procedure separately when a comprehensive code exists
Unbundling is billing individual components of a procedure separately when a single comprehensive CPT code that includes all components already exists.
What is the timely filing limit in medical billing?
Answer: The deadline set by the payer for claim submission after the date of service
Timely filing limits are payer-specific deadlines by which a claim must be submitted after the date of service or the claim will be denied.
In medical coding, what does the abbreviation 'POS' refer to on a CMS-1500 claim?
Answer: Place of Service
POS (Place of Service) codes on the CMS-1500 identify the setting where services were rendered, such as office (11), outpatient hospital (22), or inpatient hospital (21).
Which type of insurance plan typically requires a referral from a primary care physician before seeing a specialist?
Answer: HMO (Health Maintenance Organization)
HMO plans generally require patients to obtain a referral from their designated primary care physician before receiving care from a specialist.
What is a 'birthday rule' used to determine in medical billing?
Answer: Which parent's plan is primary for a dependent child covered by both parents' insurance
The birthday rule states that the plan of the parent whose birthday falls earliest in the calendar year is primary for a child covered under both parents' plans.
Which of the following best defines 'assignment of benefits' in medical billing?
Answer: The patient authorizes the insurer to pay the provider directly for services rendered
When a patient signs an assignment of benefits, they authorize their insurance company to send payment directly to the healthcare provider rather than to the patient.