Medical Billing & Coding Flashcards
7 cards from real CMAS 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 & Coding flashcards as text
Under HIPAA, the standard transaction set for electronic claims submission is:
Answer: ASC X12 837P
The ASC X12 837P (Professional) transaction is the HIPAA-mandated standard for electronic submission of professional claims.
A patient's deductible is $500. They have already met $300. How much of a $400 bill will the patient pay before insurance kicks in?
Answer: $200
The patient still needs $200 to meet the deductible ($500 - $300 = $200), so they pay $200 of the $400 bill before insurance applies.
Which code set is used to report diagnoses in outpatient and physician office settings in the United States?
Answer: ICD-10-CM
ICD-10-CM (Clinical Modification) is used by all US providers to report diagnoses in all healthcare settings.
What does an Advance Beneficiary Notice (ABN) allow a provider to do?
Answer: Collect payment from the patient if Medicare denies the claim
An ABN notifies Medicare beneficiaries that a service may not be covered, allowing the provider to bill the patient if Medicare denies payment.
Modifier -25 is used to indicate that:
Answer: A significant, separately identifiable E&M service was performed on the same day as a procedure
Modifier -25 indicates that the physician performed a significant, separately identifiable E&M service above and beyond the usual pre/post-operative care on the same day as a procedure.
What is the timely filing limit most commonly used by Medicare for initial claims submission?
Answer: 1 year from date of service
Medicare requires claims to be filed within 1 year (12 months) from the date of service for initial claim submission.
In CPT coding, what does the term 'unbundling' refer to?
Answer: Separately reporting component services that should be included in a comprehensive code
Unbundling is the improper practice of billing component parts of a procedure with separate codes instead of using the comprehensive code that includes all components.