Medical Billing Software Medical Insurance Billing 4

Question 1

What is 'balance billing' and when is it typically prohibited?

Accepted Answer

Charging a patient the difference between the billed amount and the allowed amount; prohibited for in-network providers under most contracts

Answer

Balance billing occurs when a provider bills a patient for the difference between their charge and the insurer's allowed amount, which is generally prohibited for in-network providers by their contracts.

Question 2

Which National Drug Code (NDC) format is required when billing for drugs administered in a physician's office?

Accepted Answer

11-digit format

Answer

When billing for physician-administered drugs, the NDC must be submitted in the 11-digit format (with leading zeros if necessary) as required by most payers.

Question 3

What does 'place of service' (POS) code 11 indicate on a CMS-1500 claim?

Accepted Answer

Office

Answer

POS code 11 indicates that the service was provided in a physician's office setting, which affects the reimbursement rate applied by many payers.

Question 4

Under HIPAA, which transaction standard is used for electronic claims submission from providers to payers?

Accepted Answer

ANSI X12 837

Answer

The ANSI X12 837 transaction set is the HIPAA-mandated standard electronic format for submitting healthcare claims from providers to insurance payers.

Question 5

What is a 'global period' in the context of surgical billing?

Accepted Answer

A defined postoperative timeframe during which related follow-up services are included in the surgical payment

Answer

A global period is the postoperative timeframe (typically 0, 10, or 90 days) during which routine follow-up care is bundled into the surgical fee and cannot be billed separately.

Medical Billing Software Practice Test

Medical Billing Software Practice Test

Medical Billing Software Medical Insurance Billing 4