#1
Which organization regulates medical claims processing in the United States?
CMS
ExplanationCMS regulates medical claims processing.
#2
Which of the following is NOT typically included in a medical claim?
The patient's preferred hospital cafeteria menu
ExplanationThe patient's preferred hospital cafeteria menu is not included in a medical claim.
#3
Which government agency oversees Medicaid in the United States?
Centers for Medicare & Medicaid Services (CMS)
ExplanationCMS oversees Medicaid in the United States.
#4
Which of the following is NOT a typical step in medical claims processing?
Prescription drug manufacturing
ExplanationPrescription drug manufacturing is not a typical step in claims processing.
#5
What does HIPAA stand for in the context of medical claims processing?
Health Insurance Portability and Accountability Act
ExplanationHIPAA stands for Health Insurance Portability and Accountability Act, ensuring privacy and security of patient information.
#6
What is the primary purpose of ICD codes in medical claims processing?
To categorize diseases and medical procedures
ExplanationICD codes categorize diseases and medical procedures for claims processing.
#7
Which of the following is NOT a common reason for medical claims being denied?
Expired medical license of the provider
ExplanationAn expired medical license of the provider is not a common reason for claim denial.
#8
What is a common consequence of inaccurate medical coding in claims processing?
Delayed reimbursement
ExplanationInaccurate medical coding often leads to delayed reimbursement.
#9
What is the purpose of the National Provider Identifier (NPI) in medical claims processing?
To uniquely identify healthcare providers
ExplanationThe NPI uniquely identifies healthcare providers for claims processing.
#10
What is the purpose of a Remittance Advice (RA) in medical claims processing?
To provide a summary of benefits paid by the insurance company
ExplanationRA provides a summary of benefits paid by the insurance company.
#11
What is the purpose of the CPT code system in medical claims processing?
To describe medical, surgical, and diagnostic services
ExplanationCPT codes describe medical, surgical, and diagnostic services for claims processing.