Billing Specialist Knowledge Assessment Answer Key

Name: _____________________________________________  Date: _______________

1. A CPT code has ___5_____ digits and an ICD-9-CM code has ___3-5____ digits.

 2. Explain the difference between a CPT code and an ICD-9-CM code.

CPT (Current Procedural Terminology), standardized numeric system (5 digits without modifiers) is used to report WHAT medical services and procedures are done to the patient. 

ICD9 (International Classification of Diseases – Ninth Edition) a Universal coding system is used to describe WHY a service was performed.  Codes range from 3-5 digits.  

3. What is the purpose of a modifier?

To identify in certain circumstances that a service or procedure has been altered by some specific circumstance but it has not changed the basic definition or code  (this is the literal CPT book definition, but anything remotely close to this is acceptable).

4. What are E&M codes?

Evaluation and Management Codes that describe different levels of physician “visits” in various healthcare settings.

5. What does “COB” stand for?   Coordination of Benefits

6. What insurance information do you obtain when the patient contacts our office with new insurance?

Guarantor name, guarantor DOB, guarantor policy and group number, new insurance name, address for claims submission, effective date of new policy, and (if possible) termination date of previous policy.

7.  If the patient has Medicare and Medicaid, which insurance would you bill first?

Medicare would always be billed first.                                              

8. What does HIPAA stand for? And what does it mean to you?        Health Insurance Portability and Accountability Act.

HIPAA designates certain standards and procedures that must be followed to keep secure PHI (protected Health Information). HIPAA also calls for standardization of transaction code sets and various privacy laws (looking for some level of knowledge about the general concept of HIPAA).

9.  How would you handle each of the following EOB rejections?...

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Billing Specialist Knowledge Assessment

Before you hire a biller, you need to make sure he or she is qualified for the position. The following test coupled with a math test will assess whether the candidate will be successful in the role — and an asset to your company.

Name: _____________________________________________  Date: _______________

  1. A CPT code has _______ digits and an ICD-9-CM code has _______ digits
  2. Explain the difference between a CPT code and an ICD-9-CM code
  3. What is the purpose of a modifier?
  4. What are E&M codes?
  5. What does “COB” stand for?  
  6. What insurance information do you obtain when the patient contacts our office with new insurance?
  7. If the patient has Medicare, Tricare and Medicaid, which insurance would you bill first, second, last? 
  8.  Patient is 65; has BCBS through employer w/ 100+ employees and has Medicare Part A only.  Which insurance would you file first?
  9. What does HIPAA stand for? And what does it mean to you? 
  10. What is a CMS 1500 used for?
  11. What is the difference between HCFA and CMS 1500?
  12. How would you handle each of the following EOB rejections?
    • Procedure not a covered benefit
    • Patient not eligible on the date of service
    • Applied to deductible 
    • Bundled Service

 

Multiple Choice

1. A “crossover” claim is:

a. When Medicare forwards a claim electronically to a secondary insurance carrier

b. When duplicate claims are sent and the same claim is returned for more information. (essentially the two claims are “crossing” in the mail)

c. When a claim is sent that has more than one box “crossed out”

d. Sending the claim to the secondary insurance first for administrative purposes, “crossing” the normal procedural policies.

 

2. An EOB is:

a. End of Balance

b....

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CMS Speaks: Weigh Your 2-Payer Consult Coding Options

In MSP cases, non-consult code for both payers may be best.

If you have payers who didn’t play follow-the-leader with Medicare in cutting out consult codes, you have a dilemma on your hands. You have to decide what to do...

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CMS’s Refusal to Pay Consults Makes MSP Claims a Headache

If you bill consults to private payers, good luck collecting the balance from Medicare secondary payers. Don’t even think about billing a consult to Medicare — even if it’s only a secondary payer claim. Medicare may have scratched consultations off of its list of payable services, but many other insurers did not follow suit. This leaves you in [...] Related articles:

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