Billing and Coding Basics Flashcards
6 cards from real CBCS practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 Billing and Coding Basics flashcards as text
What does the term 'accounts receivable (AR)' represent in medical billing?
Answer: Money owed to the practice for services rendered but not yet paid
Accounts receivable (AR) represents the total amount owed to a healthcare provider for services already rendered but not yet paid by payers or patients.
In ICD-10-CM, what does the 7th character extension 'A' typically indicate?
Answer: Initial encounter
In ICD-10-CM, the 7th character 'A' designates an initial encounter — the active phase of treatment when the patient is receiving definitive care for the condition.
What is a coordination of benefits (COB) situation?
Answer: When a patient has more than one insurance plan and the order of payment must be determined
Coordination of benefits occurs when a patient has coverage under two or more insurance plans. Rules determine which plan is primary (pays first) and which is secondary (pays remaining balance).
Which type of code is used to report the reason a patient sought medical care?
Answer: ICD-10-CM diagnosis code
ICD-10-CM diagnosis codes describe the patient's condition, disease, injury, or reason for the encounter. They justify the medical necessity of the services billed.
What is the purpose of a remittance advice (RA)?
Answer: To inform the provider of claim adjudication results including payments, adjustments, and denials
A remittance advice (RA), also called an Explanation of Benefits (EOB) when sent to patients, details how a payer processed a claim, including amounts paid, contractual adjustments, and denial reasons.
What does 'clean claim' mean in medical billing?
Answer: A claim that contains all required information and passes all edits without errors, allowing for immediate processing
A clean claim contains all required data elements, has no errors or missing information, and can be processed by the payer without additional information requests.