Medical Office Procedures & Billing Flashcards
7 cards from real NHI practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Medical Office Procedures & Billing flashcards as text
A patient's insurance claim is denied because the procedure code doesn't match the diagnosis code. This is called a:
Answer: Code linkage error
A code linkage error occurs when the diagnosis code does not support or justify the procedure code submitted on the claim.
Which form is used to submit professional (non-institutional) medical claims to insurance payers?
Answer: CMS-1500
The CMS-1500 form is the standard paper claim form used by physicians and other non-institutional providers to bill insurance payers.
In medical billing, what does the abbreviation 'EOB' stand for?
Answer: Explanation of Benefits
EOB stands for Explanation of Benefits, a document sent by an insurer to the patient and provider explaining what was covered and paid.
A patient schedules an appointment but fails to show up and does not call to cancel. This is documented as a:
Answer: No-show
A no-show is when a patient misses a scheduled appointment without notifying the office in advance.
When posting insurance payments, a 'contractual adjustment' represents:
Answer: The amount written off per a payer contract
A contractual adjustment is the difference between the provider's billed charge and the contracted rate that must be written off.
Which of the following best describes 'superbill' in a medical office?
Answer: A document listing diagnoses and procedures for billing purposes
A superbill (also called an encounter form) is a comprehensive list of services, diagnoses, and fees used to generate a patient's claim.
The process of verifying a patient's insurance coverage before a scheduled appointment is called:
Answer: Eligibility verification
Eligibility verification confirms that a patient has active insurance coverage and determines their benefits before the visit.