CMAA - Certified Medical Administrative Assistant Billing, Coding, and Claims Questions and Answers 1 — Questions and Answers
Question 1: A patient is seen for a follow-up visit for hypertension. The provider also performs a simple, in-office urine test. Which coding manuals should be used to report the diagnosis and services for this encounter?
- CPT® and HCPCS Level II only
- ICD-10-CM and CPT® only (Correct answer)
- ICD-10-CM only
- CPT® only
Correct answer: ICD-10-CM and CPT® only
ICD-10-CM is used to code the patient's diagnosis (hypertension). CPT® is used to code the evaluation and management service (the follow-up visit). Since a simple urine test was also performed, this would also be coded using a CPT® code. HCPCS Level II codes are typically for supplies, durable medical equipment, and services not included in CPT®, which are not indicated here.
Question 2: A CMAA is preparing a claim using a CMS-1500 form. In which block should the CMAA enter the diagnosis codes that justify the medical necessity for the services provided?
- Block 24E
- Block 17
- Block 33a
- Block 21 (Correct answer)
Correct answer: Block 21
Block 21 on the CMS-1500 claim form is designated for listing the patient's diagnosis or condition codes (ICD-10-CM codes). Up to 12 diagnoses can be listed. Block 24E is for the diagnosis pointer, which links the service in that line item to the corresponding diagnosis in Block 21. Block 17 is for the name of the referring provider, and Block 33a contains the NPI of the billing provider.
Question 3: Which of the following is the PRIMARY purpose of 'claim scrubbing' in the medical billing process?
- To bundle multiple services under a single code for higher reimbursement.
- To verify patient insurance eligibility and benefits before an appointment.
- To review claims for errors and ensure compliance with payer rules before submission. (Correct answer)
- To appeal a claim that has been denied by the insurance carrier.
Correct answer: To review claims for errors and ensure compliance with payer rules before submission.
Claim scrubbing is the process of reviewing a claim to detect and correct errors, such as incorrect codes, missing information, or violations of payer-specific rules, BEFORE it is submitted to the insurance company. This proactive review helps to increase the rate of clean claims, reduce denials, and speed up reimbursement.
Question 4: A provider performs a procedure that is justified by the patient's documented signs and symptoms and follows accepted standards of medicine. This concept, which is critical for reimbursement, is known as:
- Revenue cycle management
- Informed consent
- Medical necessity (Correct answer)
- Coordination of benefits
Correct answer: Medical necessity
Medical necessity is the principle that healthcare services or supplies are reasonable, necessary, and appropriate for the diagnosis or treatment of an illness, injury, or condition, and meet the standards of good medical practice. Payers will deny claims if they do not deem the services provided to be medically necessary.
Question 5: Which of the following code sets would be used to bill for durable medical equipment (DME), such as a walker or hospital bed, for a Medicare patient?
- ICD-10-PCS
- CPT® Category II
- HCPCS Level II (Correct answer)
- ICD-10-CM
Correct answer: HCPCS Level II
HCPCS Level II codes are used to report products, supplies, and services not included in the CPT® code set, such as ambulance services, durable medical equipment (DME), prosthetics, and certain drugs. ICD-10-CM codes are for diagnoses, ICD-10-PCS is for inpatient procedures, and CPT® Category II codes are for performance measurement.
Question 6: A CMAA is working in a provider's office and is responsible for tasks that occur after the patient has been seen and the claim has been submitted. Which of the following activities falls into the post-service phase of the revenue cycle?
- Verifying the patient's insurance eligibility.
- Collecting the patient's copayment at check-in.
- Scheduling the patient's follow-up appointment.
- Posting payments and managing claim denials. (Correct answer)
Correct answer: Posting payments and managing claim denials.
The revenue cycle includes all administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue. Activities such as posting payments received from payers (remittance processing) and managing any denied claims are key steps in the post-service, or post-payment, phase of the cycle. Insurance verification and copayment collection are pre-service tasks.
CMAA - Certified Medical Administrative Assistant Billing, Coding, and Claims Questions and Answers 1
A patient is seen for a follow-up visit for hypertension.
The provider also performs a simple, in-office urine test.
Which coding manuals should be used to report the diagnosis and services for this encounter?