CCMA Medical Billing and Coding Basics 4

Question 1

A claim is rejected because the patient's insurance ID number does not match the payer's records. What is the correct next step?

Accepted Answer

Verify the ID with the patient and correct the claim before resubmitting

Answer

Rejected claims contain errors that must be corrected before resubmission, so the ID should be verified with the patient first.

Question 2

Which ICD-10-CM code category is used to report external causes of morbidity, such as a patient injured in a car accident?

Accepted Answer

V, W, X, Y codes

Answer

In ICD-10-CM, V, W, X, and Y codes classify external causes of injury and morbidity.

Question 3

What does the term 'crossover claim' refer to in medical billing?

Accepted Answer

A claim automatically forwarded from Medicare to Medicaid for dual-eligible patients

Answer

A crossover claim is automatically sent from Medicare (primary) to Medicaid (secondary) for patients eligible for both programs.

Question 4

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?

Accepted Answer

The physician's years of experience

Answer

E/M level selection is based on medical decision making and time (or key components), not the provider's years of experience.

Question 5

What is the purpose of a Superbill (encounter form) in the medical office?

Accepted Answer

To document diagnosis and procedure codes used to generate an insurance claim

Answer

A superbill captures diagnosis and procedure codes along with fees, serving as the source document for claim generation.

CCMA - Certified Clinical Medical Assistant Practice Test