Billing, Coding, and Claims Flashcards
6 cards from real CMAA practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 Billing, Coding, and Claims flashcards as text
What is Medicare's timely filing limit for initial claim submission?
Answer: 365 days
Medicare requires initial claims within 365 days from the date of service. Late submissions are typically denied permanently.
Which modifier indicates a procedure was performed bilaterally?
Answer: Modifier -50
Modifier -50 indicates bilateral procedures. Many payers pay 150% of the unilateral rate.
What action should be taken when a claim is rejected at the clearinghouse level?
Answer: Correct the errors and resubmit
Clearinghouse rejections indicate data errors that prevented the claim from reaching the payer. Fix the errors and resubmit.
In the revenue cycle, what does 'accounts receivable' refer to?
Answer: Money owed to the practice for services rendered
Accounts receivable represents outstanding payments owed to the practice from insurance and patients for services already provided.
What is coordination of benefits (COB)?
Answer: Determining payment order when a patient has multiple insurance plans
COB determines which plan pays first (primary) and second (secondary) when a patient has multiple insurance plans.
Which form is used to submit physician service claims to Medicare?
Answer: CMS-1500
The CMS-1500 is the standard claim form for professional outpatient services to Medicare and most payers.