Medical Billing and Coding Flashcards

What is the timely filing limit for Medicare Part B claims?

Answer: 1 year (12 months) from the date of service

Medicare Part B requires claims to be submitted within 12 months (1 calendar year) of the date of service.

Which of the following actions helps verify a patient's insurance eligibility before a visit?

Answer: Checking the payer's eligibility portal or calling the insurance company directly

Verifying eligibility through the payer's portal or by phone confirms active coverage, benefits, and copay information before services are rendered.

What is an Explanation of Benefits (EOB)?

Answer: A statement from the insurance company showing how a claim was processed and what was paid

An EOB details how the insurer processed a claim, what they paid, and the patient's remaining financial responsibility.

Which of the following is an example of unbundling in medical billing?

Answer: Reporting multiple separate codes for components of a procedure that should be billed as one comprehensive code

Unbundling is a fraudulent practice of billing separately for components that should be reported as a single comprehensive CPT code.

In medical billing, what does the acronym HCPCS stand for?

Answer: Healthcare Common Procedural Coding System

HCPCS (Healthcare Common Procedure Coding System) includes CPT codes (Level I) and alphanumeric codes for supplies, equipment, and non-physician services (Level II).

What is the purpose of the National Provider Identifier (NPI)?

Answer: To uniquely identify healthcare providers in standard electronic transactions

The NPI is a unique 10-digit identifier assigned to healthcare providers under HIPAA to standardize electronic transactions.