Medical Office Administration and Billing 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 Office Administration and Billing flashcards as text
What does ICD-10-CM stand for, and what is its primary purpose in medical billing?
Answer: International Classification of Diseases, 10th revision, Clinical Modification; used to classify and code diagnoses
ICD-10-CM is the International Classification of Diseases, 10th revision, Clinical Modification — the U.S. standard coding system used to classify diagnoses, symptoms, and conditions for insurance billing, statistical analysis, and clinical documentation.
What is the purpose of the superbill (encounter form) in a medical office?
Answer: A comprehensive form listing services rendered, diagnoses, and charges used to generate insurance claims
The superbill (also called an encounter form or charge ticket) is an itemized document generated at each patient visit listing CPT procedure codes, ICD-10 diagnosis codes, charges, and provider information — used as the source document for insurance claim submission.
Which of the following best defines the term 'co-insurance' in health insurance?
Answer: The percentage of covered medical costs the patient pays after meeting the deductible
Co-insurance is the percentage of medical costs the patient is responsible for paying after the deductible has been met. For example, with an 80/20 plan, insurance pays 80% and the patient pays 20% (co-insurance).
What is a Prior Authorization (PA) and when is it required?
Answer: Advance approval from the insurance company required before certain procedures, medications, or referrals can be covered
Prior authorization is a pre-approval from a patient's insurance company that must be obtained before specific services, procedures, specialist referrals, or medications will be covered. Without PA, the claim may be denied.
When scheduling patient appointments, which scheduling system gives each appointment a fixed time slot and tends to minimize waiting room time?
Answer: Stream (fixed interval) scheduling
Stream scheduling (also called fixed interval or time-specified scheduling) assigns each patient a specific appointment time at regular intervals (e.g., every 15–30 minutes). When followed, it minimizes patient wait times.
A patient calls to schedule a procedure but their insurance has not yet responded to the prior authorization request. What is the most appropriate response?
Answer: Inform the patient that the authorization is pending, provide an estimated timeframe, and schedule only after authorization is received or based on physician guidance
Scheduling a procedure before receiving prior authorization risks claim denial and unexpected patient financial liability. The appropriate response is to communicate transparently with the patient, continue following up with the payer, and schedule only after authorization is confirmed or per the physician's guidance for urgent cases.