Free CCMA Medical Billing and Coding Basics Questions and Answers 1 — Questions and Answers
Question 1: Which coding system is used to report diagnoses and conditions on insurance claims?
- CPT
- HCPCS Level II
- ICD-10-CM (Correct answer)
- NDC
Correct answer: ICD-10-CM
The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) is the standard system used by healthcare providers to classify and code all diagnoses, symptoms, and procedures. This system is essential for billing and tracking disease prevalence.
Question 2: A fixed amount that a patient pays for a covered healthcare service at the time of the visit is called a(n):
- Deductible
- Copayment (Correct answer)
- Coinsurance
- Premium
Correct answer: Copayment
A copayment, or copay, is a set amount determined by the insurance plan that the patient must pay for a specific service, such as a doctor's visit or prescription. This is different from a deductible, which is the amount paid out-of-pocket before insurance begins to pay.
Question 3: Which claim form is used by physicians and other non-institutional providers to bill for their services?
- UB-04
- CMS-1490S
- EOB
- CMS-1500 (Correct answer)
Correct answer: CMS-1500
The CMS-1500 form is the standard paper claim form used by healthcare professionals and suppliers to bill Medicare Part B, Medicaid, and other insurance carriers for services rendered. The UB-04 form is used by facilities like hospitals.
Question 4: Which government-sponsored insurance program primarily covers individuals aged 65 and older?
- Medicaid
- TRICARE
- Medicare (Correct answer)
- CHAMPVA
Correct answer: Medicare
Medicare is a federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease. Medicaid is a joint federal and state program that helps with medical costs for some people with limited income and resources.
Question 5: In medical billing, what does the acronym 'EOB' stand for?
- Estimate of Billing
- Explanation of Benefits (Correct answer)
- End of Business
- Electronic Office Billing
Correct answer: Explanation of Benefits
An Explanation of Benefits (EOB) is a statement sent by a health insurance company to covered individuals explaining what medical treatments and/or services were paid for on their behalf. It is not a bill, but rather a summary of the claim and payment details.
Question 6: Current Procedural Terminology (CPT) codes are used to identify what?
- Patient diagnoses
- Medical equipment and supplies
- Medical services and procedures (Correct answer)
- Prescription drugs
Correct answer: Medical services and procedures
CPT codes are a uniform language for describing medical, surgical, and diagnostic services rendered to patients. These codes are used by insurers to determine the amount of reimbursement a practitioner will receive.
Free CCMA Medical Billing and Coding Basics Questions and Answers 1
Which coding system is used to report diagnoses and conditions on insurance claims?