CBCS Billing and Claims Submission 2

Question 1

Which box on the CMS-1500 claim form is used to enter the patient's diagnosis codes?

Accepted Answer

Box 21

Answer

Box 21 on the CMS-1500 contains the diagnosis codes (ICD-10-CM) for the encounter. Up to 12 diagnosis codes can be entered, labeled A through L.

Question 2

What is the timely filing limit for Medicare claims?

Accepted Answer

1 year (12 months) from date of service

Answer

Medicare requires claims to be filed within 12 months (1 calendar year) from the date of service. Claims submitted after this deadline will be denied for timely filing.

Question 3

What is the purpose of the National Correct Coding Initiative (NCCI) edits?

Accepted Answer

To prevent improper payment of CPT code combinations that should not be billed together on the same date of service

Answer

NCCI edits consist of code pair edits and medically unlikely edits (MUEs) that CMS uses to prevent inappropriate payment of bundled code combinations or unlikely units of service.

Question 4

What does 'crossover claim' refer to in Medicare billing?

Accepted Answer

A claim that Medicare automatically forwards to Medicaid (or a Medigap plan) after adjudicating its portion

Answer

A crossover claim is automatically sent from Medicare to the secondary payer (typically Medicaid or a Medicare Supplement/Medigap plan) after Medicare processes the claim, eliminating the need for the provider to submit a separate claim.

Question 5

What information is contained in Box 33 of the CMS-1500 claim form?

Accepted Answer

The billing provider's name, address, phone number, and NPI

Answer

Box 33 contains the billing provider's (or group practice's) name, address, phone number, and NPI — the entity responsible for submitting the claim and receiving payment.

(CBCS) Certified Billing and Coding Specialist Practice Test

(CBCS) Certified Billing and Coding Specialist Practice Test

CBCS Billing and Claims Submission 2