Medical Billing and Coding 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 Medical Billing and Coding flashcards as text
What does 'upcoding' refer to in medical billing?
Answer: Reporting a higher-level service than was actually performed
Upcoding is fraudulently reporting a more expensive service than the one provided.
A patient owes a fixed dollar amount at each visit regardless of charges. This is a:
Answer: Copayment
A copayment is a set flat fee the patient pays per visit or service.
Which document must a Medicare patient sign before receiving a service Medicare may not cover?
Answer: Advance Beneficiary Notice (ABN)
An ABN notifies the patient they may be financially responsible if Medicare denies the service.
What is the main function of HCPCS Level II codes?
Answer: Reporting supplies, equipment, and non-physician services
HCPCS Level II codes cover items like durable medical equipment, drugs, and supplies not in CPT.
A claim is returned because the patient's policy number was entered incorrectly. This is a:
Answer: Rejected claim
A rejected claim is returned for correction due to errors before being processed.
Coinsurance of 20% means the patient pays:
Answer: 20% of the allowed amount after the deductible
Coinsurance is the patient's percentage share of the allowed amount once the deductible is met.
Which set of guidelines protects the privacy of patient billing information?
Answer: HIPAA
HIPAA governs the privacy and security of protected health information including billing data.