CMC Reimbursement & Claims Processing 3

Question 1

When a Medicare patient has end-stage renal disease (ESRD) and employer group health plan coverage, which payer is primary during the first 30 months?

Accepted Answer

The employer group health plan is primary for the first 30 months

Answer

For ESRD patients with employer group health plan coverage, the group health plan is primary during a 30-month coordination period before Medicare becomes primary.

Question 2

A provider submits a claim for a service performed on January 15. Medicare's timely filing limit is 12 months from the date of service. What is the last date the claim can be submitted?

Accepted Answer

January 15 of the following year

Answer

Medicare requires claims to be submitted within one calendar year (12 months) from the date of service, so a service on January 15 must be filed by January 15 of the following year.

Question 3

What does NCCI stand for in medical coding and billing?

Accepted Answer

National Correct Coding Initiative

Answer

NCCI (National Correct Coding Initiative) is a CMS program that promotes correct coding by preventing improper payment of Medicare Part B claims.

Question 4

Which type of edit would prevent payment for a surgical approach code billed separately from the primary procedure?

Accepted Answer

Column 1/Column 2 NCCI edit

Answer

Column 1/Column 2 NCCI edits bundle component codes (Column 2) with comprehensive codes (Column 1), preventing separate payment for integral parts of a procedure.

Question 5

Under the Medicare Physician Fee Schedule, which component of the Resource-Based Relative Value Scale (RBRVS) reflects the overhead costs of running a practice?

Accepted Answer

Practice Expense RVU

Answer

Practice Expense RVUs account for the overhead costs associated with providing a service, such as staff salaries, supplies, and equipment.

(CMC) Certified Medical Coder Practice Test

(CMC) Certified Medical Coder Practice Test

CMC Reimbursement & Claims Processing 3