RMA Medical Billing and Coding 3 — Questions and Answers
Question 1: What does 'upcoding' refer to in medical billing?
- Reporting a higher-level service than was actually performed (Correct answer)
- Submitting a claim late
- Using an outdated code book
- Billing two payers at once
Correct answer: Reporting a higher-level service than was actually performed
Upcoding is fraudulently reporting a more expensive service than the one provided.
Question 2: A patient owes a fixed dollar amount at each visit regardless of charges. This is a:
- Copayment (Correct answer)
- Coinsurance
- Deductible
- Premium
Correct answer: Copayment
A copayment is a set flat fee the patient pays per visit or service.
Question 3: Which document must a Medicare patient sign before receiving a service Medicare may not cover?
- Advance Beneficiary Notice (ABN) (Correct answer)
- HIPAA authorization
- Superbill
- Remittance advice
Correct answer: Advance Beneficiary Notice (ABN)
An ABN notifies the patient they may be financially responsible if Medicare denies the service.
Question 4: What is the main function of HCPCS Level II codes?
- Reporting supplies, equipment, and non-physician services (Correct answer)
- Reporting diagnoses
- Reporting hospital room charges
- Reporting patient demographics
Correct answer: Reporting supplies, equipment, and non-physician services
HCPCS Level II codes cover items like durable medical equipment, drugs, and supplies not in CPT.
Question 5: A claim is returned because the patient's policy number was entered incorrectly. This is a:
- Rejected claim (Correct answer)
- Paid claim
- Capitated claim
- Bundled claim
Correct answer: Rejected claim
A rejected claim is returned for correction due to errors before being processed.
Question 6: Coinsurance of 20% means the patient pays:
- 20% of the allowed amount after the deductible (Correct answer)
- A flat $20 fee
- 20% of the premium
- Nothing until the deductible doubles
Correct answer: 20% of the allowed amount after the deductible
Coinsurance is the patient's percentage share of the allowed amount once the deductible is met.
Question 7: Which set of guidelines protects the privacy of patient billing information?
- HIPAA (Correct answer)
- OSHA
- CLIA
- FMLA
Correct answer: HIPAA
HIPAA governs the privacy and security of protected health information including billing data.
RMA Medical Billing and Coding 3
What does 'upcoding' refer to in medical billing?