CCBMA Medical Billing and Coding 2 — Questions and Answers
Question 1: Which of the following describes the difference between a deductible and a copayment?
- A copayment is paid annually; a deductible is paid per visit
- A deductible is the amount paid before insurance kicks in; a copayment is a fixed amount paid per visit (Correct answer)
- They are the same thing described differently by each insurer
- A deductible applies only to prescriptions; a copayment applies only to office visits
Correct answer: A deductible is the amount paid before insurance kicks in; a copayment is a fixed amount paid per visit
A deductible is the annual out-of-pocket threshold a patient must meet before insurance pays; a copayment is a fixed per-visit fee.
Question 2: A medical assistant discovers a billing error in which a service was billed but not performed. The correct action is to:
- Leave it as is to avoid drawing attention
- Report it immediately to the billing supervisor for correction (Correct answer)
- Submit a new claim with additional services to compensate
- Ask the patient to pay the amount out of pocket
Correct answer: Report it immediately to the billing supervisor for correction
Billing for services not rendered constitutes fraud; immediate reporting and correction is legally and ethically required.
Question 3: What is upcoding in medical billing?
- Correcting an underbilled service code to the appropriate level
- Reporting a higher-level service code than what was actually provided to receive greater reimbursement (Correct answer)
- Updating outdated CPT codes to the current year's edition
- Adding modifier codes to increase claim specificity
Correct answer: Reporting a higher-level service code than what was actually provided to receive greater reimbursement
Upcoding is fraudulent billing that reports a more expensive service than was performed to obtain higher reimbursement.
Question 4: Which form is typically used to submit claims to Medicare and most other insurance carriers for physician services?
- UB-04
- CMS-1500 (Correct answer)
- ADA dental claim form
- HIPAA 834 enrollment form
Correct answer: CMS-1500
The CMS-1500 form is the standard paper claim form used by non-institutional providers to bill Medicare and most commercial insurers.
Question 5: What does prior authorization mean in the context of insurance billing?
- Collecting the patient's copay before the visit
- Approval from the insurance company required before certain services are rendered (Correct answer)
- Confirming the patient's identity before treatment
- Notifying the patient of their deductible amount
Correct answer: Approval from the insurance company required before certain services are rendered
Prior authorization is advance approval from the payer confirming that a specific service will be covered before it is performed.
Question 6: Which modifier is appended to a CPT code to indicate that a procedure was performed bilaterally?
- -51
- -50 (Correct answer)
- -59
- -25
Correct answer: -50
Modifier -50 indicates that a procedure was performed on both sides of the body during the same operative session.
CCBMA Medical Billing and Coding 2
Which of the following describes the difference between a deductible and a copayment?