CCBMA Medical Billing and Coding 2

Question 1

Which of the following describes the difference between a deductible and a copayment?

Accepted Answer

A deductible is the amount paid before insurance kicks in; a copayment is a fixed amount paid per visit

Answer

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:

Accepted Answer

Report it immediately to the billing supervisor for correction

Answer

Billing for services not rendered constitutes fraud; immediate reporting and correction is legally and ethically required.

Question 3

What is upcoding in medical billing?

Accepted Answer

Reporting a higher-level service code than what was actually provided to receive greater reimbursement

Answer

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?

Accepted Answer

CMS-1500

Answer

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?

Accepted Answer

Approval from the insurance company required before certain services are rendered

Answer

Prior authorization is advance approval from the payer confirming that a specific service will be covered before it is performed.

CCBMA - California Certifying Board for Medical Assistants Practice Test