Medical Office Procedures & Billing Flashcards
7 cards from real NHI practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Medical Office Procedures & Billing flashcards as text
A Medicare patient is responsible for paying 20% of the Medicare-approved amount after the deductible. This payment is called a:
Answer: Coinsurance
Coinsurance is a percentage of the approved amount that the patient pays after meeting their deductible; Medicare Part B coinsurance is typically 20%.
Which HIPAA standard transaction set is used for healthcare claim submission?
Answer: 837
The HIPAA 837 transaction set is used for electronic submission of healthcare claims to payers.
A medical office receives a payment from a secondary insurance payer. Which of the following should the biller do FIRST?
Answer: Verify the primary insurance payment was applied first
Before applying a secondary payment, the biller must confirm the primary insurance has already processed and paid the claim.
What is the purpose of the National Provider Identifier (NPI)?
Answer: To uniquely identify healthcare providers in standard transactions
The NPI is a unique 10-digit identification number assigned to each covered healthcare provider for use in HIPAA standard transactions.
A patient's balance after all insurance payments have been applied and adjustments made is called the:
Answer: Patient responsibility
Patient responsibility is the remaining amount owed by the patient after all insurance payments and contractual adjustments have been posted.
In scheduling terminology, 'double-booking' means:
Answer: Scheduling two patients for the same appointment slot
Double-booking is the practice of scheduling two patients for the same time slot, often used to accommodate urgent cases or reduce no-shows.
Which coding system is used to report medical procedures and services for reimbursement in the United States?
Answer: CPT (Current Procedural Terminology)
CPT codes, maintained by the American Medical Association, are used to report medical, surgical, and diagnostic procedures to payers for reimbursement.