MDA121 Clinical Aspects of Billing and Coding

What is MOST important to have on file before billing a standard medical insurance?

A code set is data used to document reasons patients are seen for exams.

Level I CPT codes are 5-digit codes reporting services provided.

CPT Level I and HCPCS Level II can be used interchangeably.

Stand alone codes, stand alone with the full description of the procedure.

When a patient has coverage from more than one insurance, the primary insurance is

Patients enrolled in Medicare Part A

What is the term for the amount of money at patient must pay before insurance benefits pay?

What description best describes a level of care that involves multiple systems or complex involvement of a system?

An ABN on file insures the insurance will pay for the procedure.

ICD-10-CM and CPT have the same codes.

There are incentives through Medicare and Medicaid programs for billers to use EHR technology when billing.

Which is true about ICD-10-CM codes?

Obtaining pre-certification will guarantee payment.

Assignment of benefits means that the patient has benefits.

Which component is not considered when determining appropriate level of E/M?

ICD-10 codes are

A default code is the ICD-10 code most commonly associate with the main term.

The 'Birthday Rule' determines who's plan will cover the children?

Modifying terms are descriptive words under main terms to provide further descriptions of procedure.

The word part -rrhexis means flow.

In the Tabular List of Diseases, ICD-10-CM codes in Chapter 1 begin with A00.

Which part of Medicare pays for provider fees, diagnostic tests and medical equipment?

Which of the following is an ICD code?

When billing for immunizations during a well-child visit, which coding book would you use?

Which is an Evaluation and Management (E/M) code?

E/M codes are CPT codes NOT used for

Which is a CPT code?

Nonavailability means services are not available.

Which is the amount paid to an insurance company for health benefits?

Which is a reason a claim would be denied?

What is the allowable charge?

Assignment of benefits means you are informing the patient in advance that Medicare may not pay for a procedure.

HCPCS codes are for medical, surgical and diagnostic codes, related to Medicare.

Instructional notes guide you to find the most appropriate diagnosis code.

A covered entity refers to anyone/any business exposed to patients' care/medical records.

A main term is the identifying word that helps you find the correct diagnosis code.