Billing, Coding, and Claims Flashcards
7 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 7 Billing, Coding, and Claims flashcards as text
A physician performs a laceration repair and also removes a skin tag during the same visit. How should the skin tag removal be billed?
Answer: Bill separately with modifier -51 appended to the secondary procedure
When multiple procedures are performed at the same session, modifier -51 (Multiple Procedures) is appended to the secondary/lower-value procedure.
Which federal law mandates standard electronic transaction code sets and establishes privacy protections for health information?
Answer: HIPAA
HIPAA (Health Insurance Portability and Accountability Act) established national standards for electronic health care transactions and protected health information.
A claim is denied because the service requires a referral authorization that was not obtained. This is an example of which type of denial?
Answer: Administrative denial
An administrative denial occurs due to procedural or policy issues such as missing authorizations, eligibility problems, or incomplete information.
On the CMS-1500 form, Box 21 requires diagnosis codes. How many diagnosis codes can be listed in Box 21?
Answer: Up to 12
The current version of the CMS-1500 (02/12) allows up to 12 diagnosis codes to be listed in Box 21.
Which code set is used to report supplies, durable medical equipment, and services not covered by CPT codes for Medicare billing?
Answer: HCPCS Level II
HCPCS Level II codes (alphanumeric, starting with A–V) are used to bill Medicare and Medicaid for supplies, DME, injections, and other services not in CPT.
A patient receives services from both an in-network and an out-of-network provider during a single hospital stay. What billing term describes this situation?
Answer: Balance billing exposure
Balance billing exposure occurs when an out-of-network provider bills the patient for the difference between their charge and the insurer's allowed amount.
What does the term 'clean claim' mean in medical billing?
Answer: A claim submitted without errors that can be processed without additional information
A clean claim is one that is complete, accurate, and contains all required information so the payer can process it without requesting additional data.