CBCS Billing and Claims Submission 2

Question 1

Which box on the CMS-1500 claim form is used to enter the patient's diagnosis codes?

Accepted Answer

Box 21

Answer

Box 24D

Answer

Box 33

Answer

Box 11

Question 2

What is the timely filing limit for Medicare claims?

Accepted Answer

1 year (12 months) from date of service

Answer

90 days from date of service

Answer

6 months from date of service

Answer

2 years from date of service

Question 3

What is the purpose of the National Correct Coding Initiative (NCCI) edits?

Accepted Answer

To prevent improper payment of CPT code combinations that should not be billed together on the same date of service

Answer

To validate that diagnosis codes match the procedure codes billed

Answer

To identify upcoded E/M services in physician billing

Answer

To check patient eligibility before claim submission

Question 4

What does 'crossover claim' refer to in Medicare billing?

Accepted Answer

A claim that Medicare automatically forwards to Medicaid (or a Medigap plan) after adjudicating its portion

Answer

A claim submitted to both Medicare and a commercial payer simultaneously

Answer

A claim that crosses fiscal years in Medicare processing

Answer

A claim transferred from one Medicare Administrative Contractor to another

Question 5

What information is contained in Box 33 of the CMS-1500 claim form?

Accepted Answer

The billing provider's name, address, phone number, and NPI

Answer

The patient's diagnosis codes

Answer

The referring physician's name and NPI

Answer

The date and place of service

Question 6

What is a secondary claim in medical billing?

Accepted Answer

A claim submitted after the primary insurer has processed and paid their portion, sent to the secondary insurer to cover remaining balances

Answer

A duplicate claim submitted for the same service

Answer

A claim for a secondary diagnosis unrelated to the primary reason for the visit

Answer

A corrected claim replacing a previously submitted claim