Administrative and Office Management Flashcards

What is the purpose of the superbill (encounter form) in a medical office?

Answer: To document services rendered and link diagnoses to procedure codes for billing

The superbill captures the visit's diagnoses (ICD codes) and procedures (CPT codes), serving as the primary source document for claim submission.

Which coding system is used to report diagnoses on medical claims in the United States?

Answer: ICD-10-CM (International Classification of Diseases)

ICD-10-CM codes are used to report diagnoses, symptoms, and conditions on all healthcare claims submitted in the United States.

What is a prior authorization in medical billing?

Answer: Pre-approval from a payer required before certain services are covered

Prior authorization is a payer requirement that specific services be approved in advance to confirm medical necessity before the patient receives care.

Which scheduling method assigns specific appointment slots to specific types of visits (e.g., physical exams in the morning, follow-ups in the afternoon)?

Answer: Cluster scheduling

Cluster scheduling groups similar types of appointments into designated time blocks, improving efficiency by standardizing preparation and resources needed.

What does 'accounts receivable' (AR) represent in a medical practice?

Answer: Money owed to the practice for services already rendered

Accounts receivable represents the outstanding payments owed to the practice by patients and insurance companies for services that have already been provided.

Which type of managed care plan requires patients to select a primary care physician (PCP) who coordinates all their medical care?

Answer: Health Maintenance Organization (HMO)

HMOs require enrollees to choose a PCP who serves as the gatekeeper for all specialist referrals and coordinates the patient's care within the network.