RMA Medical Billing and Coding 2

Question 1

Which code set is used to report diagnoses on a CMS-1500 claim form?

Accepted Answer

ICD-10-CM

Answer

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?

Accepted Answer

Secondary insurance

Answer

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?

Accepted Answer

The maximum the insurer will pay for a service

Answer

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?

Accepted Answer

Evaluation and Management

Answer

Office and outpatient visits are reported with Evaluation and Management (E/M) codes.

Question 5

A clean claim is best defined as one that:

Accepted Answer

Has no errors and can be processed without additional information

Answer

A clean claim contains all required, accurate information so it processes without delay or rejection.

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