Medical Billing and Coding Basics Flashcards
6 cards from real CCMA 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 Basics flashcards as text
What is the purpose of a CMS-1500 form?
Answer: To submit medical claims to insurance companies for reimbursement
The CMS-1500 is the universal paper claim form used by physicians and other non-institutional providers to submit claims to Medicare, Medicaid, and most commercial insurers.
Which ICD-10-CM coding rule requires the most specific diagnosis code available to be used?
Answer: Code to the highest level of specificity
ICD-10-CM guidelines require coding to the highest level of specificity — using the most detailed code that accurately describes the diagnosis.
What does the term 'clean claim' mean in medical billing?
Answer: A claim submitted without errors that can be processed immediately for payment
A clean claim is one that contains all required information with no errors or missing data, allowing the payer to process it immediately without requesting additional information.
A modifier in medical coding is used to:
Answer: Provide additional information about a procedure without changing its definition
A modifier is a two-digit code appended to a CPT code that provides additional information about the circumstances of the procedure without changing the procedure's definition.
When a provider accepts Medicare assignment, they agree to:
Answer: Accept Medicare's approved fee as full payment for covered services
Accepting Medicare assignment means the provider accepts Medicare's approved fee as full payment, collecting only the 20% coinsurance from the patient.
What does the 'place of service' (POS) code 11 indicate on a CMS-1500 claim form?
Answer: Office (physician's office)
POS code 11 designates the physician's office as the location where services were rendered.