Medical Billing and Coding Basics Flashcards
7 cards from real CCMA practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Medical Billing and Coding Basics flashcards as text
A claim is rejected because the patient's insurance ID number does not match the payer's records. What is the correct next step?
Answer: Verify the ID with the patient and correct the claim before resubmitting
Rejected claims contain errors that must be corrected before resubmission, so the ID should be verified with the patient first.
Which ICD-10-CM code category is used to report external causes of morbidity, such as a patient injured in a car accident?
Answer: V, W, X, Y codes
In ICD-10-CM, V, W, X, and Y codes classify external causes of injury and morbidity.
What does the term 'crossover claim' refer to in medical billing?
Answer: A claim automatically forwarded from Medicare to Medicaid for dual-eligible patients
A crossover claim is automatically sent from Medicare (primary) to Medicaid (secondary) for patients eligible for both programs.
A coder assigns CPT code 99213 for an established patient office visit. Which factor is NOT used to determine the level of E/M service?
Answer: The physician's years of experience
E/M level selection is based on medical decision making and time (or key components), not the provider's years of experience.
What is the purpose of a Superbill (encounter form) in the medical office?
Answer: To document diagnosis and procedure codes used to generate an insurance claim
A superbill captures diagnosis and procedure codes along with fees, serving as the source document for claim generation.
Under HIPAA, which standard transaction set is used for electronic submission of professional healthcare claims?
Answer: ASC X12 837P
The HIPAA 837P transaction is the electronic standard for submitting professional (physician) claims.
A patient has both Medicare Part B and a Medigap policy. Which payer is billed first?
Answer: Medicare Part B, as it is the primary payer
Medicare Part B is always the primary payer for Medicare beneficiaries; Medigap pays after Medicare processes the claim.