AMT CMAS flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Guarantor

The person legally responsible for paying a patient's bill, who may be the patient or another party such as a parent or spouse.

Superbill

An encounter form listing the date, provider, diagnoses, procedures, and charges for a visit; it is the source document for charge entry.

Accounts receivable aging

A report grouping unpaid balances by age, commonly 0-30, 31-60, 61-90, and over 90 days, used to prioritize collection follow-up.

Release of information

A patient-signed authorization permitting disclosure of protected health information to a named party for a stated purpose and time period.

Suffix -itis

A word ending meaning inflammation, as in dermatitis (skin inflammation) or gastritis (stomach inflammation).

Prefix hypo-

A prefix meaning below, under, or deficient, as in hypotension (low blood pressure) or hypothyroidism (underactive thyroid).

SOAP note

A progress note organized as Subjective, Objective, Assessment, and Plan, separating patient-reported information from exam findings and the treatment plan.

Suffix -ectomy

A word ending meaning surgical removal, as in appendectomy (removal of the appendix) or cholecystectomy (removal of the gallbladder).

Clean claim rate

The percentage of claims accepted on first submission without edits or denials, a key measure of revenue-cycle efficiency.

Contractual adjustment

The difference between the provider's billed charge and the payer's allowed amount, which the provider writes off under the contract.

Coordination of benefits

The rule determining which payer is primary when a patient has multiple coverages; the primary pays first and the secondary considers the remainder.

Days in accounts receivable

Total accounts receivable divided by average daily charges, indicating the average number of days needed to collect outstanding balances.

Medicare timely filing

The deadline for submitting claims to Medicare, generally 12 months from the date of service, after which claims are denied.

ICD-10-CM

The diagnosis code set used in the United States, with codes of 3 to 7 characters describing condition, body site, laterality, and encounter type.

Code first convention

An ICD-10-CM instruction requiring the underlying etiology code to be sequenced before the manifestation code in a related pair.

Modifier 25

A CPT modifier indicating a significant, separately identifiable evaluation and management service was performed on the same day as a procedure.

HCPCS Level II

A code set covering supplies, drugs, and equipment not described by CPT, including J-codes for injectables and E-codes for equipment.

Outpatient probable diagnosis rule

In outpatient coding, a condition documented only as probable, suspected, or rule out is not coded as confirmed; code the presenting signs or symptoms instead.

Medicare Part B

The Medicare component covering physician services, outpatient care, and durable medical equipment, generally financed through premiums.

Copayment

A fixed dollar amount the patient pays at the time of service, distinct from coinsurance, which is a percentage of the allowed amount.

Prior authorization

Payer approval obtained before a service is rendered; missing required authorization commonly causes a denial that may be appealed.

Explanation of Benefits

A payer statement showing billed charges, allowed amount, payer payment, and patient responsibility; it is not itself a bill.

COBRA

A law allowing continuation of group health coverage for a limited period after a qualifying event such as job loss.

Scope of practice

The set of duties a medical assistant may legally perform, determined by state law and the delegation of a supervising clinician.

Standard precautions

Infection-control practices treating all blood and body fluids as potentially infectious, including hand hygiene and use of personal protective equipment.

Professional boundaries

Limits that keep the clinician-patient relationship therapeutic, prohibiting personal or financial entanglements and gifts that could influence care.

Teach-back method

A communication technique in which the patient restates instructions in their own words to confirm understanding.

Active listening

A communication technique using paraphrasing, reflection, and open-ended questions to verify the speaker's meaning.

Qualified medical interpreter

A trained interpreter used for clinical communication when a patient has limited English proficiency, rather than a family member or minor.

Minimum necessary standard

A HIPAA principle limiting uses and disclosures of protected health information to the least amount needed for the stated purpose.

Informed consent

A patient's voluntary agreement to treatment after receiving information about risks, benefits, and alternatives, obtained by the treating clinician.

HIPAA breach notification

The requirement to notify affected individuals of a breach of unsecured protected health information, generally within 60 days of discovery.