CBCS Exam Flashcards

Q: What topics do CBCS flashcards cover?

These CBCS flashcards cover revenue cycle terms, compliance, insurance eligibility, ICD-10-CM, CPT, HCPCS, claims, reimbursement, denials, and appeals.

Q: Are CBCS flashcards useful for billing and coding exam prep?

Yes. Flashcards help build quick recall for billing and coding vocabulary, but candidates should also practice coding scenarios and claim workflow questions.

Q: How should I study CBCS flashcards?

Review a small set daily, separate cards you miss, and connect each term to the claim life cycle so you can answer workflow-based exam questions.

Question 1

Revenue cycle

Accepted Answer

The full process from scheduling and registration through coding, claim submission, payment posting, denial follow-up, and collections. It matters because errors early can delay payment later.

Question 2

Patient registration

Accepted Answer

Collecting demographics, insurance, consent, and contact information before or during the visit. Accurate registration prevents eligibility problems, claim rejections, and billing delays.

Question 3

Charge capture

Accepted Answer

Recording services, supplies, and procedures provided during care. Complete charge capture supports accurate coding, compliant billing, and appropriate reimbursement.

Question 4

Clean claim

Accepted Answer

A claim with complete, accurate information that can be processed without additional investigation. Clean claims reduce denials, rework, and accounts receivable delays.

Question 5

HIPAA

Accepted Answer

Federal law that protects health information and sets privacy and security requirements. CBCS candidates must understand minimum necessary use, permitted disclosures, and safeguards.

Question 6

PHI

Accepted Answer

Protected Health Information is individually identifiable health information in any form. PHI must be handled carefully because improper disclosure can harm patients and create penalties.

Question 7

Minimum necessary

Accepted Answer

Using or disclosing only the PHI needed for the purpose. This principle reduces privacy risk during billing, coding, release of information, and payer communication.

Question 8

HITECH

Accepted Answer

A law that strengthened electronic health information protections and breach-related requirements. It matters because billing and coding workflows often involve electronic PHI.

Question 9

False Claims Act

Accepted Answer

A federal law addressing knowingly false or fraudulent claims submitted for payment. Accurate coding and documentation help prevent overbilling and fraud exposure.

Question 10

Fraud vs abuse

Accepted Answer

Fraud is intentional deception for improper payment; abuse is a practice inconsistent with accepted standards that can cause unnecessary cost. Both require compliance attention.

Question 11

OIG compliance plan

Accepted Answer

A structured program to prevent, detect, and correct healthcare fraud and abuse risks. It commonly includes policies, training, auditing, reporting, and corrective action.

Question 12

Eligibility verification

Accepted Answer

Confirming active coverage, benefits, copays, deductibles, referrals, and authorization rules before service when possible. Verification reduces denials and surprise patient balances.

Question 13

Coordination of benefits

Accepted Answer

Determining which insurance plan pays first when a patient has more than one payer. Correct COB prevents duplicate payment and claim processing delays.

Question 14

Primary payer

Accepted Answer

The insurance plan responsible for paying first. Identifying the primary payer correctly is essential before submitting claims to secondary or tertiary coverage.

Question 15

Prior authorization

Accepted Answer

Payer approval obtained before certain services, medications, or procedures. Missing authorization can result in denial even when the service was medically necessary.

Question 16

Referral

Accepted Answer

A direction from one provider to another, often required by managed care plans. Referral requirements must be checked because missing referrals can affect payment.

Question 17

Medical necessity

Accepted Answer

The requirement that a service be reasonable and necessary for diagnosis or treatment. Diagnosis codes and documentation must support why the service was needed.

Question 18

ABN

Accepted Answer

Advance Beneficiary Notice of Noncoverage tells a Medicare patient that a service may not be covered. It supports informed patient financial responsibility.

Question 19

Deductible

Accepted Answer

The amount a patient must pay before the plan begins paying covered benefits. Knowing deductible status helps estimate patient responsibility.

Question 20

Copayment vs coinsurance

Accepted Answer

A copayment is a fixed amount; coinsurance is a percentage of allowed charges. Both affect patient balances after payer processing.

Question 21

ICD-10-CM

Accepted Answer

The diagnosis coding system used to report conditions, symptoms, and reasons for encounters. Diagnosis codes support medical necessity and risk adjustment.

Question 22

First-listed diagnosis

Accepted Answer

The diagnosis chiefly responsible for the outpatient encounter, listed first. Correct sequencing affects medical necessity, reporting accuracy, and payer review.

Question 23

Laterality

Accepted Answer

Code detail that identifies right, left, bilateral, or unspecified side. Using documented laterality improves specificity and can prevent claim edits.

Question 24

Combination code

Accepted Answer

One ICD-10-CM code that captures multiple related elements, such as a condition and manifestation. Use it when the code book supports the complete documented concept.

Question 25

Excludes1 note

Accepted Answer

An ICD-10-CM instruction meaning two codes should not be reported together because the conditions cannot occur together or are mutually exclusive.

Question 26

Excludes2 note

Accepted Answer

An ICD-10-CM instruction meaning a condition is not included in the code, but both codes may be reported together when both conditions exist.

Question 27

CPT

Accepted Answer

The code set used to report medical, surgical, diagnostic, and E/M services. CPT selection must match documentation and current coding guidelines.

Question 28

HCPCS Level II

Accepted Answer

Codes used for supplies, drugs, durable medical equipment, ambulance services, and other items not fully captured by CPT. They often matter for payer billing.

Question 29

E/M coding

Accepted Answer

Evaluation and Management coding reports provider visits and related cognitive work. Office and outpatient levels are commonly selected by MDM or total time.

Question 30

Medical decision-making

Accepted Answer

An E/M leveling method based on problems, data, and risk. It matters because documentation must support the selected level of service.

Question 31

Modifier

Accepted Answer

A two-character code appended to clarify how a service was performed or should be processed. Modifiers can affect payment, bundling, and denial decisions.

Question 32

Modifier 25

Accepted Answer

Identifies a significant, separately identifiable E/M service on the same day as another service or procedure. Documentation must support the separate E/M work.

Question 33

Modifier 50

Accepted Answer

Reports a bilateral procedure when appropriate under CPT and payer rules. It matters because bilateral services often have special reimbursement handling.

Question 34

Modifier 59

Accepted Answer

Identifies a distinct procedural service when no more specific modifier applies. It should not be used just to bypass edits without documentation support.

Question 35

Global surgical package

Accepted Answer

A payment concept that includes routine preoperative, intraoperative, and postoperative services related to a procedure. Unrelated care may require separate reporting with support.

Question 36

Unbundling

Accepted Answer

Reporting separate codes for components that are included in a more comprehensive code. Unbundling can create improper payment and compliance risk.

Question 37

Provider query

Accepted Answer

A compliant request for clarification when documentation is incomplete, conflicting, or unclear. Queries help coders avoid unsupported upcoding or downcoding.

Question 38

CMS-1500

Accepted Answer

The standard professional claim form used for many provider and outpatient professional services. Accurate patient, payer, diagnosis, and procedure fields are essential.

Question 39

UB-04

Accepted Answer

The institutional claim form used by hospitals and facilities. It includes facility-specific data such as revenue codes, type of bill, and service units.

Question 40

EDI

Accepted Answer

Electronic Data Interchange transmits healthcare transactions such as claims and remittance advice electronically. EDI improves speed but still requires accurate data.

Question 41

Clearinghouse

Accepted Answer

An intermediary that checks and routes electronic claims between providers and payers. Clearinghouse rejections must be corrected before payer adjudication occurs.

Question 42

Claim rejection

Accepted Answer

A claim returned before payer adjudication, often for missing or invalid data. Rejections are corrected and resubmitted, unlike formal denials after review.

Question 43

Claim denial

Accepted Answer

A payer refusal to pay after adjudication. Denials require analysis of the reason code, documentation, payer policy, and appeal or correction options.

Question 44

EOB

Accepted Answer

Explanation of Benefits sent to the patient showing how a claim was processed, including allowed amount, payment, adjustment, and patient responsibility.

Question 45

ERA

Accepted Answer

Electronic Remittance Advice is the electronic version of payment and adjustment information from a payer. It supports automated payment posting and reconciliation.

Question 46

Allowed amount

Accepted Answer

The payer-approved amount for a covered service. Payment, contractual adjustment, and patient responsibility are calculated from this amount.

Question 47

Contractual adjustment

Accepted Answer

The write-off between the billed charge and the payer's allowed amount under contract. It is not billed to the patient when contract rules apply.

Question 48

Payment posting

Accepted Answer

Recording payer and patient payments, adjustments, and denials in the billing system. Accurate posting drives correct balances and follow-up work.

Question 49

Aging report

Accepted Answer

A report that groups unpaid accounts by how long they have been outstanding. It helps prioritize follow-up and identify revenue cycle problems.

Question 50

Appeal

Accepted Answer

A formal request for a payer to reconsider a denial or payment decision. Effective appeals use documentation, policy references, and timely filing rules.

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