Medical Billing and Coding Flashcards
6 cards from real NCMA practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 Medical Billing and Coding flashcards as text
What does the acronym CPT stand for in medical billing?
Answer: Current Procedural Terminology
CPT (Current Procedural Terminology) is a medical code set maintained by the American Medical Association (AMA) used to describe medical, surgical, and diagnostic services for billing and documentation purposes.
What is the purpose of the ICD-10-CM coding system in healthcare billing?
Answer: To classify and code diagnoses, symptoms, and reasons for patient encounters for billing and statistical purposes
ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification) codes classify diseases, conditions, injuries, and reasons for healthcare encounters, supporting billing, reimbursement, epidemiology, and quality reporting.
On a CMS-1500 claim form, where is the patient's primary diagnosis code entered?
Answer: Box 21 (Diagnosis or Nature of Illness or Injury)
Box 21 of the CMS-1500 form is where up to 12 ICD-10-CM diagnosis codes are entered; each procedure code in Box 24D then references the applicable diagnosis code(s) by letter (A–L) to show medical necessity.
What is an Explanation of Benefits (EOB)?
Answer: A document from the insurance company detailing what was billed, what was allowed, what was paid, and what remains the patient's responsibility
An Explanation of Benefits (EOB) is sent by the insurer after processing a claim, summarizing the billed amount, allowed amount, insurer's payment, contractual adjustment, and any balance owed by the patient.
What is a superbill (encounter form) used for in a medical office?
Answer: A pre-printed or electronic form listing common diagnosis and procedure codes used to document services rendered during a patient visit for billing purposes
A superbill is an itemized receipt of services that lists the provider's common CPT and ICD-10-CM codes; the provider checks off the services rendered and diagnoses, which the billing staff then uses to generate the claim.
What does it mean when an insurance claim is 'denied' versus 'rejected'?
Answer: A denial is processed but payment is refused (can be appealed); a rejection is returned before processing due to errors (must be corrected and resubmitted)
A rejected claim is returned to the submitter before processing because of technical errors (missing data, invalid codes); a denied claim is processed by the payer but payment is refused for clinical or coverage reasons — denials can be appealed but rejections must be corrected first.