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Medical Billing and Coding Flashcards
| Front | Back |
| Define reimbursement in medical billing | The payment received by a provider for services rendered to patients from insurance companies or other payers |
| What are the primary steps of the insurance claim process? | Patient registration service documentation coding claim submission insurance processing payment posting and follow-up |
| What does CPT stand for? | Current Procedural Terminology |
| What does the term clean claim refer to? | A claim that is submitted without errors and meets all requirements facilitating quicker payment |
| What is a claim form in medical billing? | A form submitted to an insurance company by a healthcare provider to request payment for services rendered |
| What is a co-payment? | A fixed fee a patient pays for a covered healthcare service at the time of receiving care |
| What is a deductible in health insurance? | The amount a patient must pay out-of-pocket before their insurance begins to cover services |
| What is a denial in medical billing? | A refusal by an insurance company to pay for a medical claim |
| What is a superbill? | A detailed form used by healthcare providers to communicate billing information for patient services to a billing department or medical coder |
| What is co-insurance? | The percentage of costs a patient pays for a covered healthcare service after meeting their deductible |
| What is EDI in medical billing? | Electronic Data Interchange the electronic submission of medical claims |
| What is FHIR in medical coding? | Fast Healthcare Interoperability Resources a standard for exchanging healthcare information electronically |
| What is the difference between CPT and ICD-10 codes? | CPT codes describe medical procedures and services while ICD-10 codes classify diagnoses |
| What is the difference between in-network and out-of-network providers? | In-network providers have agreements with insurance companies for negotiated rates while out-of-network providers do not |
| What is the difference between primary and secondary insurance? | Primary insurance pays first for covered services while secondary insurance may cover remaining costs |
| What is the National Correct Coding Initiative (NCCI)? | A program to promote national correct coding methodologies and to control improper coding leading to inappropriate payment |
| What is the purpose of ICD-10 codes? | To classify and code all diagnoses symptoms and procedures associated with hospital care |
| What is the purpose of modifier codes in CPT? | To provide additional information about procedures indicating special circumstances or alterations |
| What is the revenue cycle in medical billing? | The process from patient registration to final payment of a patient account |
| What is the role of a medical biller? | To submit and follow up on claims with health insurance companies to receive payment for medical services |
| What is the role of a medical coder? | To translate healthcare diagnoses procedures and services into universal medical alphanumeric codes |
Front
What is a claim form in medical billing?
Click the card to flip
Back
A form submitted to an insurance company by a healthcare provider to request payment for services rendered
Front
What is a superbill?
Back
A detailed form used by healthcare providers to communicate billing information for patient services to a billing department or medical coder
Front
What is the purpose of modifier codes in CPT?
Back
To provide additional information about procedures indicating special circumstances or alterations
Front
What is EDI in medical billing?
Back
Electronic Data Interchange the electronic submission of medical claims
Front
What is a co-payment?
Back
A fixed fee a patient pays for a covered healthcare service at the time of receiving care
Front
What is the difference between CPT and ICD-10 codes?
Back
CPT codes describe medical procedures and services while ICD-10 codes classify diagnoses
Front
What does CPT stand for?
Back
Current Procedural Terminology
Front
Define reimbursement in medical billing
Back
The payment received by a provider for services rendered to patients from insurance companies or other payers
Front
What are the primary steps of the insurance claim process?
Back
Patient registration service documentation coding claim submission insurance processing payment posting and follow-up
Front
What does the term clean claim refer to?
Back
A claim that is submitted without errors and meets all requirements facilitating quicker payment
Front
What is co-insurance?
Back
The percentage of costs a patient pays for a covered healthcare service after meeting their deductible
Front
What is the difference between primary and secondary insurance?
Back
Primary insurance pays first for covered services while secondary insurance may cover remaining costs
Front
What is the purpose of ICD-10 codes?
Back
To classify and code all diagnoses symptoms and procedures associated with hospital care
Front
What is the role of a medical biller?
Back
To submit and follow up on claims with health insurance companies to receive payment for medical services
Front
What is a denial in medical billing?
Back
A refusal by an insurance company to pay for a medical claim
Front
What is the National Correct Coding Initiative (NCCI)?
Back
A program to promote national correct coding methodologies and to control improper coding leading to inappropriate payment
Front
What is FHIR in medical coding?
Back
Fast Healthcare Interoperability Resources a standard for exchanging healthcare information electronically
Front
What is the revenue cycle in medical billing?
Back
The process from patient registration to final payment of a patient account
Front
What is the difference between in-network and out-of-network providers?
Back
In-network providers have agreements with insurance companies for negotiated rates while out-of-network providers do not
Front
What is a deductible in health insurance?
Back
The amount a patient must pay out-of-pocket before their insurance begins to cover services
Front
What is the role of a medical coder?
Back
To translate healthcare diagnoses procedures and services into universal medical alphanumeric codes
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This deck covers essential billing processes, CPT and ICD-10 coding systems, insurance claim procedures, and reimbursement methods crucial for accurate medical billing and coding practices.