Technology & Digital Applications Flashcards
7 cards from real Certified Medical Coding Specialist practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Technology & Digital Applications flashcards as text
What is the purpose of a 'scrubber' in medical billing software?
Answer: To automatically check claims for errors before submission to payers
A claim scrubber analyzes claims for coding errors, missing information, and payer-specific rule violations before submission to reduce denials.
Which HIPAA transaction standard is used for electronic eligibility and benefit inquiry?
Answer: X12 270/271
The X12 270 (inquiry) and 271 (response) transaction set is the HIPAA standard for verifying a patient's insurance eligibility and benefits electronically.
A coder receives a remittance advice (ERA) with remark code CO-4. What does this typically indicate?
Answer: The procedure code is inconsistent with the modifier used
CO-4 is a CARC (Claim Adjustment Reason Code) indicating the procedure code is inconsistent with the modifier or requires a different modifier for billing.
What is the function of a 'superbill' in a medical practice's digital workflow?
Answer: A document listing services rendered during a visit used to generate charges
A superbill (encounter form) is a structured document completed after a visit listing diagnoses and procedures, serving as the source for charge entry into the PMS.
Which technology allows real-time data exchange between EHR systems using modern web standards, as mandated by ONC?
Answer: FHIR (Fast Healthcare Interoperability Resources)
FHIR is the modern ONC-endorsed standard using RESTful APIs to enable real-time, standardized data exchange between healthcare systems.
When a provider's EHR system sends a lab result to a specialist's system, which interoperability framework is MOST commonly used?
Answer: HL7 messaging
HL7 (Health Level 7) messaging standards, including v2 and FHIR, are the predominant frameworks for exchanging clinical data like lab results between systems.
A computer-assisted coding (CAC) system assigns a code that the coder disagrees with after reviewing the documentation. The coder should:
Answer: Override the code with the correct code and document the reason
Coders retain professional responsibility for final code assignment; CAC suggestions must be reviewed and overridden when incorrect, with the change documented.