Medical Billing and Coding Flashcards
6 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 6 Medical Billing and Coding flashcards as text
Which coding system is used to report physician and outpatient procedures and services to insurance carriers?
Answer: CPT
Current Procedural Terminology (CPT) codes are used to report medical, surgical, and diagnostic procedures and services performed by physicians and other healthcare providers.
What does the term 'EOB' stand for in medical billing?
Answer: Explanation of Benefits
EOB stands for Explanation of Benefits, which is a document sent by the insurance company to the patient and/or provider explaining what was covered and paid for a claim.
Which ICD-10-CM code type is used when a definitive diagnosis has not yet been established?
Answer: Symptom codes
When a definitive diagnosis has not been established, symptom or sign codes from ICD-10-CM are used to describe the patient's presenting complaint.
What is a superbill in medical practice?
Answer: A detailed itemized list of services provided during a visit used for billing
A superbill is a comprehensive encounter form that lists all diagnoses, procedures, and charges for a patient visit and is used to generate insurance claims.
Which form is used to submit claims to Medicare Part B?
Answer: CMS-1500
The CMS-1500 form is the standard paper claim form used by non-institutional providers (such as physician offices) to bill Medicare Part B and most other payers.
What is the purpose of prior authorization in medical billing?
Answer: To obtain advance approval from an insurer before providing certain services
Prior authorization (also called pre-authorization or pre-approval) is the process of obtaining advance approval from a patient's insurance company before specific services, medications, or procedures are provided.