RMA Medical Billing and Coding 2 — Questions and Answers
Question 1: Which code set is used to report diagnoses on a CMS-1500 claim form?
- ICD-10-CM (Correct answer)
- CPT
- HCPCS Level II
- NDC
Correct answer: ICD-10-CM
ICD-10-CM codes report patient diagnoses, while CPT and HCPCS report services and supplies.
Question 2: A patient's insurance pays after the primary plan has paid. What is this plan called?
- Secondary insurance (Correct answer)
- Capitation plan
- Self-pay
- Workers' compensation
Correct answer: Secondary insurance
Secondary insurance pays remaining balances after the primary payer processes the claim.
Question 3: What does the term 'allowed amount' mean on an explanation of benefits?
- The maximum the insurer will pay for a service (Correct answer)
- The full provider charge
- The patient's annual deductible
- The total of all claims filed
Correct answer: The maximum the insurer will pay for a service
The allowed amount is the contracted maximum an insurer recognizes for a covered service.
Question 4: Which CPT code category covers a routine office visit for an established patient?
- Evaluation and Management (Correct answer)
- Anesthesia
- Radiology
- Pathology and Laboratory
Correct answer: Evaluation and Management
Office and outpatient visits are reported with Evaluation and Management (E/M) codes.
Question 5: A clean claim is best defined as one that:
- Has no errors and can be processed without additional information (Correct answer)
- Was submitted on paper
- Includes only one procedure code
- Was paid in full at first submission
Correct answer: Has no errors and can be processed without additional information
A clean claim contains all required, accurate information so it processes without delay or rejection.
Question 6: What is the purpose of a CPT modifier?
- To provide additional detail about a service without changing its core definition (Correct answer)
- To replace the diagnosis code
- To indicate the patient's insurance type
- To set the provider's fee
Correct answer: To provide additional detail about a service without changing its core definition
Modifiers add detail such as laterality or multiple procedures without altering the base code's meaning.
Question 7: Which form is most commonly used by physician offices to submit professional claims?
- CMS-1500 (Correct answer)
- UB-04
- ABN
- W-9
Correct answer: CMS-1500
The CMS-1500 is the standard claim form for physician and outpatient professional services.
RMA Medical Billing and Coding 2
Which code set is used to report diagnoses on a CMS-1500 claim form?