Medical Billing and Coding Flashcards
7 cards from real CMA 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 flashcards as text
What does the National Provider Identifier (NPI) represent?
Answer: A unique 10-digit identification number assigned to healthcare providers
The NPI is a unique 10-digit number assigned by CMS to identify healthcare providers in standard electronic transactions.
Which diagnosis coding guideline applies when a patient presents with signs and symptoms but no definitive diagnosis has been established?
Answer: Code the signs and symptoms themselves
For outpatient encounters, ICD-10-CM guidelines require coding the signs and symptoms when no confirmed diagnosis exists, rather than coding an uncertain condition.
A physician performs a procedure and wants to indicate the service was greater than usually required. Which modifier should be used?
Answer: -22
Modifier -22 (Increased Procedural Services) is used when the work required is substantially greater than typically required, and supporting documentation must accompany the claim.
What is the timely filing limit, and what happens if a claim is submitted after this deadline?
Answer: The payer will deny the claim and the provider generally cannot bill the patient for the balance
Timely filing limits define the window to submit claims; late submission results in denial, and the provider typically cannot collect from the patient for a billing error.
Which type of audit reviews a sample of claims AFTER payment to identify potential overpayments or compliance issues?
Answer: Retrospective audit
A retrospective audit reviews claims and documentation after services have been rendered and payment made, identifying billing errors or fraud.
In CPT, what is the correct way to report a service that is not represented by any existing code?
Answer: Use an unlisted procedure code and submit with a special report
Unlisted procedure codes (e.g., 99499, 27899) are used for services with no specific CPT code, and a special report describing the service must accompany the claim.
What is the difference between a co-pay and a co-insurance?
Answer: A co-pay is a fixed dollar amount due at the time of service; co-insurance is a percentage of the allowed amount
A co-pay is a set dollar amount (e.g., $25) collected at the visit, while co-insurance is a percentage (e.g., 20%) of the allowed amount the patient owes after the deductible.