CCMA Medical Billing and Coding Basics 2

Question 1

What is the purpose of a CMS-1500 form?

Accepted Answer

To submit medical claims to insurance companies for reimbursement

Answer

To document patient consent for treatment

Answer

To record a patient's complete medical history

Answer

To request prior authorization for procedures

Question 2

Which ICD-10-CM coding rule requires the most specific diagnosis code available to be used?

Accepted Answer

Code to the highest level of specificity

Answer

Use unspecified codes whenever possible

Answer

Code only the primary diagnosis

Answer

Use combination codes for all chronic conditions

Question 3

What does the term 'clean claim' mean in medical billing?

Accepted Answer

A claim submitted without errors that can be processed immediately for payment

Answer

A claim that has been audited for fraud

Answer

A claim for preventive services only

Answer

A claim with a zero balance owed

Question 4

A modifier in medical coding is used to:

Accepted Answer

Provide additional information about a procedure without changing its definition

Answer

Replace a CPT code with a more general code

Answer

Override insurance coverage limitations permanently

Answer

Indicate that a claim was filed late

Question 5

When a provider accepts Medicare assignment, they agree to:

Accepted Answer

Accept Medicare's approved fee as full payment for covered services

Answer

Charge any amount above the Medicare allowed fee

Answer

Bill the patient for the full billed amount regardless of Medicare's fee schedule

Answer

Refer all Medicare patients to a hospital setting

Question 6

What does the 'place of service' (POS) code 11 indicate on a CMS-1500 claim form?

Accepted Answer

Office (physician's office)

Answer

Hospital inpatient

Answer

Emergency room

Answer

Ambulatory surgical center