Insurance and Reimbursement Flashcards
7 cards from real RMA practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Insurance and Reimbursement flashcards as text
ICD-10-CM codes are used to report what on a claim?
Answer: Diagnoses and reasons for the visit
ICD-10-CM codes describe the patient's diagnosis or condition.
CPT codes are used primarily to report:
Answer: Medical procedures and services
CPT codes identify the procedures and services a provider performs.
What is the function of a CPT modifier?
Answer: To provide additional detail about a service without changing its definition
Modifiers add specificity to a procedure code, such as indicating a bilateral or repeat service.
HCPCS Level II codes are used to report items such as:
Answer: Durable medical equipment, supplies, and certain drugs
HCPCS Level II codes cover supplies, equipment, and products not found in CPT.
'Upcoding' refers to which fraudulent practice?
Answer: Billing a higher-level code than the service warrants
Upcoding is reporting a more expensive service than was actually provided.
What is 'unbundling' in medical coding?
Answer: Billing separately for procedures that should be reported under a single comprehensive code
Unbundling improperly splits a bundled service into multiple codes to increase reimbursement.
The 'point of service' field on a claim links a procedure to its:
Answer: Supporting diagnosis
Linking a procedure to the correct diagnosis demonstrates medical necessity for the service.