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The document provides a series of questions and answers related to insurance, claims processing, and medical coding. It covers topics such as Medicare coverage, claim denials, EOBs, and coding systems like CPT and ICD-10-CM. Key points include the role of modifiers, the importance of accurate patient demographics, and the use of specific forms like UB-04 for institutional billing.

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30 views1 page

Answers

The document provides a series of questions and answers related to insurance, claims processing, and medical coding. It covers topics such as Medicare coverage, claim denials, EOBs, and coding systems like CPT and ICD-10-CM. Key points include the role of modifiers, the importance of accurate patient demographics, and the use of specific forms like UB-04 for institutional billing.

Uploaded by

kasargattamanasa08
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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1.

This Insurance generally does not cover prescription drugs:


Answer: Medicare Part D
2. QW Modifier may be applied to this CPT group:
Answer: 80xxx
3. Medicare becomes a secondary payer in presence of:
Answer: All of the above (Third Party Insurance, Worker's Compensation, Large Group Insurance)
4. Time period that a claim has been pending for response from Insurance is shown in:
Answer: Ageing reports
5. Which of these is NOT a valid reason for claim denial?
Answer: Claim filed within timely filing limit
6. What is the primary purpose of an EOB (Explanation of Benefits)?
Answer: To explain how a claim was processed and what amount was paid
7. Which of the following is a HIPAA-covered entity?
Answer: Healthcare clearinghouse
8. Which code set is used for reporting medical diagnoses?
Answer: ICD-10-CM
9. Which of these is NOT an appealable denial reason?
Answer: Non-covered service
10. The UB-04 form is used for:
Answer: Institutional billing
11. What is the standard time limit for submitting Medicare claims?
Answer: 12 months from the date of service
12. Which of the following is a common reason for claim rejection?
Answer: Invalid patient demographics
13. A CPT code describes:
Answer: Procedures and services performed
14. Which modifier indicates a repeat procedure by the same physician?
Answer: Modifier 76
15. Which of the following is NOT a common cause of claim denials?
Answer: Accurate Codes
16. Which one of the following CPTs can represent a Nursing Facility visit?
Answer: 99306
17. Number of digits in NPI:
Answer: None of the Above (NPI has 10 digits)
18. This figure gives the total amount outstanding on a specific date from insurance and patients:
Answer: Current AR
19. Sequence of characters used to uniquely refer to an insurance company:
Answer: Payer ID

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