CMA Medical Billing and Coding 5

Question 1

What does the National Provider Identifier (NPI) represent?

Accepted Answer

A unique 10-digit identification number assigned to healthcare providers

Answer

The NPI is a unique 10-digit number assigned by CMS to identify healthcare providers in standard electronic transactions.

Question 2

Which diagnosis coding guideline applies when a patient presents with signs and symptoms but no definitive diagnosis has been established?

Accepted Answer

Code the signs and symptoms themselves

Answer

For outpatient encounters, ICD-10-CM guidelines require coding the signs and symptoms when no confirmed diagnosis exists, rather than coding an uncertain condition.

Question 3

A physician performs a procedure and wants to indicate the service was greater than usually required. Which modifier should be used?

Accepted Answer

-22

Answer

Modifier -22 (Increased Procedural Services) is used when the work required is substantially greater than typically required, and supporting documentation must accompany the claim.

Question 4

What is the timely filing limit, and what happens if a claim is submitted after this deadline?

Accepted Answer

The payer will deny the claim and the provider generally cannot bill the patient for the balance

Answer

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.

Question 5

Which type of audit reviews a sample of claims AFTER payment to identify potential overpayments or compliance issues?

Accepted Answer

Retrospective audit

Answer

A retrospective audit reviews claims and documentation after services have been rendered and payment made, identifying billing errors or fraud.

Certified Medical Assistant Exam Practice Test

Certified Medical Assistant Exam Practice Test

CMA Medical Billing and Coding 5