Coding & Billing Basics
What does CPT stand for?
What is Current Procedural Terminology.
What is the first step in the revenue cycle?
What is patient registration.
What federal law governs patient privacy?
What is HIPAA.
What is a charge capture audit?
What is a review to ensure all services provided are billed.
What is a denial?
What is a refusal by a payer to reimburse a claim.
Which code set is used for diagnoses?
What is ICD-10.
What department typically handles charge entry?
What is the billing department.
What does CMS stand for?
What is Centers for Medicare & Medicaid Services.
What system is often used to track charges?
What is the CDM (Charge Description Master).
What is the first step in appealing a denial?
What is reviewing the denial reason and documentation.
What modifier indicates a distinct procedural service?
What is Modifier 59.
What is the purpose of a scrubber tool?
What is to check claims for errors before submission.
What is the OIG responsible for?
What is investigating fraud and abuse in healthcare.
What is a common error found in charge audits?
What is missing or duplicate charges.
What is a common cause of medical necessity denials?
What is lack of supporting documentation.
What is the purpose of HCPCS codes?
What is to report supplies, equipment, and services not included in CPT.
What does EDI stand for?
What is Electronic Data Interchange.
What is a common penalty for non-compliance with billing regulations?
What is financial fines or exclusion from Medicare.
What is the purpose of reconciliation reports?
What is to compare services rendered vs. charges billed.
What is the difference between a hard denial and a soft denial?
What is hard denials cannot be reversed; soft denials can be appealed.
What is the difference between facility and professional billing?
What is facility billing covers overhead costs; professional billing covers provider services.
What is the role of a Revenue Integrity Analyst?
What is to ensure accurate charge capture, coding, and billing compliance.
What is the False Claims Act?
What is a law that penalizes fraudulent billing to government programs.
What is a soft edit in charge capture?
What is a warning that doesn’t prevent billing but flags potential issues.
What is the timely filing limit for Medicare appeals?
What is 120 days from the initial determination.