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Medical Billing and Coding Flashcards
AAMA CMA Flashcards
| 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 |
This deck covers essential billing processes, CPT and ICD-10 coding systems, insurance claim procedures, and reimbursement methods crucial for accurate medical billing and coding practices.