Medical Billing and Coding Flashcards
7 cards from real RMA 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 Billing and Coding flashcards as text
Which code set is used to report diagnoses on a CMS-1500 claim form?
Answer: ICD-10-CM
ICD-10-CM codes report patient diagnoses, while CPT and HCPCS report services and supplies.
A patient's insurance pays after the primary plan has paid. What is this plan called?
Answer: Secondary insurance
Secondary insurance pays remaining balances after the primary payer processes the claim.
What does the term 'allowed amount' mean on an explanation of benefits?
Answer: The maximum the insurer will pay for a service
The allowed amount is the contracted maximum an insurer recognizes for a covered service.
Which CPT code category covers a routine office visit for an established patient?
Answer: Evaluation and Management
Office and outpatient visits are reported with Evaluation and Management (E/M) codes.
A clean claim is best defined as one that:
Answer: Has no errors and can be processed without additional information
A clean claim contains all required, accurate information so it processes without delay or rejection.
What is the purpose of a CPT modifier?
Answer: To provide additional detail about a service without changing its core definition
Modifiers add detail such as laterality or multiple procedures without altering the base code's meaning.
Which form is most commonly used by physician offices to submit professional claims?
Answer: CMS-1500
The CMS-1500 is the standard claim form for physician and outpatient professional services.