NCMA Medical Billing and Coding 2

Question 1

What does the acronym CPT stand for in medical billing?

Accepted Answer

Current Procedural Terminology

Answer

CPT (Current Procedural Terminology) is a medical code set maintained by the American Medical Association (AMA) used to describe medical, surgical, and diagnostic services for billing and documentation purposes.

Question 2

What is the purpose of the ICD-10-CM coding system in healthcare billing?

Accepted Answer

To classify and code diagnoses, symptoms, and reasons for patient encounters for billing and statistical purposes

Answer

ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification) codes classify diseases, conditions, injuries, and reasons for healthcare encounters, supporting billing, reimbursement, epidemiology, and quality reporting.

Question 3

On a CMS-1500 claim form, where is the patient's primary diagnosis code entered?

Accepted Answer

Box 21 (Diagnosis or Nature of Illness or Injury)

Answer

Box 21 of the CMS-1500 form is where up to 12 ICD-10-CM diagnosis codes are entered; each procedure code in Box 24D then references the applicable diagnosis code(s) by letter (A–L) to show medical necessity.

Question 4

What is an Explanation of Benefits (EOB)?

Accepted Answer

A document from the insurance company detailing what was billed, what was allowed, what was paid, and what remains the patient's responsibility

Answer

An Explanation of Benefits (EOB) is sent by the insurer after processing a claim, summarizing the billed amount, allowed amount, insurer's payment, contractual adjustment, and any balance owed by the patient.

Question 5

What is a superbill (encounter form) used for in a medical office?

Accepted Answer

A pre-printed or electronic form listing common diagnosis and procedure codes used to document services rendered during a patient visit for billing purposes

Answer

A superbill is an itemized receipt of services that lists the provider's common CPT and ICD-10-CM codes; the provider checks off the services rendered and diagnoses, which the billing staff then uses to generate the claim.

NCMA - National Certified Medical Assistant Practice Test

NCMA - National Certified Medical Assistant Practice Test

NCMA Medical Billing and Coding 2