CCMA Medical Billing and Coding Basics 5

Question 1

Which modifier is appended to a CPT code to indicate that a procedure was performed on the left side of the body?

Accepted Answer

-LT

Answer

Modifier -LT (Left Side) is used to identify procedures performed on the left side of the body.

Question 2

What is a 'clean claim' in medical billing?

Accepted Answer

A claim submitted without errors that can be processed and paid without additional information

Answer

A clean claim contains all required information and no errors, allowing the payer to adjudicate it without requesting additional data.

Question 3

The Relative Value Unit (RVU) system used in Medicare's RBRVS fee schedule consists of which three components?

Accepted Answer

Work, practice expense, and malpractice

Answer

RVUs are composed of physician work, practice expense, and malpractice expense components, each adjusted by a geographic factor.

Question 4

When a provider does not have a contract with a patient's insurance plan, the provider is considered:

Accepted Answer

Non-participating (out-of-network)

Answer

A non-participating or out-of-network provider has no contractual agreement with the payer, often resulting in lower reimbursement and higher patient cost-sharing.

Question 5

Which of the following best describes 'upcoding' in medical billing?

Accepted Answer

Assigning a higher-level code than the service documented to increase reimbursement

Answer

Upcoding is the fraudulent practice of billing for a higher-level service than was actually provided or documented.

CCMA - Certified Clinical Medical Assistant Practice Test

CCMA - Certified Clinical Medical Assistant Practice Test

CCMA Medical Billing and Coding Basics 5