CCBMA Medical Billing and Coding 1 — Questions and Answers
Question 1: Which coding system is used to report medical diagnoses on insurance claims in the United States?
- CPT
- ICD-10-CM (Correct answer)
- HCPCS Level II
- DRG
Correct answer: ICD-10-CM
ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification) is used to report diagnoses on US insurance claims.
Question 2: What does CPT stand for in medical billing?
- Comprehensive Patient Treatment
- Current Procedural Terminology (Correct answer)
- Clinical Payment Terms
- Certified Provider Transactions
Correct answer: Current Procedural Terminology
CPT (Current Procedural Terminology) codes, maintained by the AMA, describe medical, surgical, and diagnostic services.
Question 3: Which of the following is an example of a clean claim?
- A claim submitted with missing patient date of birth
- A claim submitted with all required, accurate information and no errors (Correct answer)
- A claim with an unspecified diagnosis code
- A claim submitted after the filing deadline
Correct answer: A claim submitted with all required, accurate information and no errors
A clean claim contains all required information, has no errors, and can be processed without additional information.
Question 4: What is the purpose of a superbill in a medical office?
- To track employee payroll
- To itemize services rendered and diagnostic codes for billing purposes (Correct answer)
- To request prior authorization from the insurance company
- To document patient consent for treatment
Correct answer: To itemize services rendered and diagnostic codes for billing purposes
A superbill lists all services, procedures, and diagnoses for a patient encounter and is used to generate the insurance claim.
Question 5: Which federal program provides health insurance primarily for patients aged 65 and older?
- Medicaid
- Medicare (Correct answer)
- CHIP
- TRICARE
Correct answer: Medicare
Medicare is a federal health insurance program primarily for individuals aged 65 and older and certain younger people with disabilities.
Question 6: What does the term 'coordination of benefits' mean in medical billing?
- Determining which physician is the primary provider
- The process of determining which insurance plan pays first when a patient has multiple coverages (Correct answer)
- Confirming patient eligibility with the payer
- Submitting claims to multiple states simultaneously
Correct answer: The process of determining which insurance plan pays first when a patient has multiple coverages
Coordination of benefits (COB) determines the order in which multiple insurance plans pay to prevent duplicate payments.
CCBMA Medical Billing and Coding 1
Which coding system is used to report medical diagnoses on insurance claims in the United States?