Billing and Claims Submission Flashcards
6 cards from real CBCS practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 Billing and Claims Submission flashcards as text
Which box on the CMS-1500 claim form is used to enter the patient's diagnosis codes?
Answer: Box 21
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.
What is the timely filing limit for Medicare claims?
Answer: 1 year (12 months) from date of service
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.
What is the purpose of the National Correct Coding Initiative (NCCI) edits?
Answer: To prevent improper payment of CPT code combinations that should not be billed together on the same date of service
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.
What does 'crossover claim' refer to in Medicare billing?
Answer: A claim that Medicare automatically forwards to Medicaid (or a Medigap plan) after adjudicating its portion
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.
What information is contained in Box 33 of the CMS-1500 claim form?
Answer: The billing provider's name, address, phone number, and NPI
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.
What is a secondary claim in medical billing?
Answer: A claim submitted after the primary insurer has processed and paid their portion, sent to the secondary insurer to cover remaining balances
A secondary claim is submitted to a patient's secondary insurance after the primary insurer has adjudicated the claim. It includes the primary insurance's payment information so the secondary can determine how much they owe.