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Medical Billing and Coding Flashcards
AAMA CMA Flashcards
Study our Medical Billing and Coding flashcards for the AAMA CMA exam with 21+ flashcards. View as flashcards, a searchable table, or as a fun matching game.
| Front | Back |
| Define reimbursement in medical billing | The payment received by a provider for services rendered to patients from insurance companies or other payers |
| What are the primary steps of the insurance claim process? | Patient registration service documentation coding claim submission insurance processing payment posting and follow-up |
| What does CPT stand for? | Current Procedural Terminology |
| What does the term clean claim refer to? | A claim that is submitted without errors and meets all requirements facilitating quicker payment |
| What is a claim form in medical billing? | A form submitted to an insurance company by a healthcare provider to request payment for services rendered |
| What is a co-payment? | A fixed fee a patient pays for a covered healthcare service at the time of receiving care |
| What is a deductible in health insurance? | The amount a patient must pay out-of-pocket before their insurance begins to cover services |
| What is a denial in medical billing? | A refusal by an insurance company to pay for a medical claim |
| What is a superbill? | A detailed form used by healthcare providers to communicate billing information for patient services to a billing department or medical coder |
| What is co-insurance? | The percentage of costs a patient pays for a covered healthcare service after meeting their deductible |
| What is EDI in medical billing? | Electronic Data Interchange the electronic submission of medical claims |
| What is FHIR in medical coding? | Fast Healthcare Interoperability Resources a standard for exchanging healthcare information electronically |
| What is the difference between CPT and ICD-10 codes? | CPT codes describe medical procedures and services while ICD-10 codes classify diagnoses |
| What is the difference between in-network and out-of-network providers? | In-network providers have agreements with insurance companies for negotiated rates while out-of-network providers do not |
| What is the difference between primary and secondary insurance? | Primary insurance pays first for covered services while secondary insurance may cover remaining costs |
| What is the National Correct Coding Initiative (NCCI)? | A program to promote national correct coding methodologies and to control improper coding leading to inappropriate payment |
| What is the purpose of ICD-10 codes? | To classify and code all diagnoses symptoms and procedures associated with hospital care |
| What is the purpose of modifier codes in CPT? | To provide additional information about procedures indicating special circumstances or alterations |
| What is the revenue cycle in medical billing? | The process from patient registration to final payment of a patient account |
| What is the role of a medical biller? | To submit and follow up on claims with health insurance companies to receive payment for medical services |
| What is the role of a medical coder? | To translate healthcare diagnoses procedures and services into universal medical alphanumeric codes |
About the Flashcards
Flashcards for the AAMA CMA exam give you a concise way to master the language of medical coding and billing. Each card reinforces essential definitions, from CPT and ICD-10 code sets to the steps of the revenue cycle, ensuring you can quickly recall how procedures, diagnoses, and payment data are systematically recorded.
Use the deck to solidify your understanding of claim creation and submission, insurance processing, reimbursement terminology, and patient financial responsibilities such as deductibles and co-insurance. It also highlights electronic standards like EDI and FHIR, modifier usage, and NCCI guidelines so you are ready to answer application-level questions on test day.
Topics covered in this flashcard deck:
- CPT vs. ICD-10
- Revenue cycle steps
- Claim forms & submission
- Insurance terms & reimbursement
- EDI, FHIR, NCCI standards
- Modifier & clean claims