Test your basic knowledge |

Medical Billing Claims Basics

Instructions:
  • Answer 50 questions in 15 minutes.
  • If you are not ready to take this test, you can study here.
  • Match each statement with the correct term.
  • Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.
1. Established proce set by a medical practice for proefessional services






2. Patient who owes a balance on the account who has moved without a forwarding address






3. Procedure codes match the diagnosis codes -procedure are not elective -procedures are not exprimental -procedures are essentail for treatment -procedures are furnished at a appropriate level






4. Promote interest and well being of the patients and residents of healthcare facility






5. Billing for each item service provided to a patient in accourdance with insurance carriers' policies






6. Listing of claims that have incorrect information such as posting error or missing information to process a claim






7. Term for processing payment






8. Conditions - situations - and services not covered by the insurance carrier






9. Group 2 or more physicians and non-physicians practitioners legally organized in a partnership - professional corporation - foundation - not-for-profit corporation - faculty pratice plan - or similar assoc






10. Assigned to the physician by Medicare program






11. Discount or fee exception given to a patient at the discretion of the physician






12. Group 2 or more physicians and non-physicians practitioners legally organized in a partnership - professional corporation - foundation - not-for-profit corporation - faculty pratice plan - or similar assoc






13. A report to track claim status of patient accounts and to identify individual accounts requiring additional workup for payments or write-offs






14. Passed by the federal government to prosecute cases of Medicaid fraud






15. Procedure or services provided without proper authorizationor was not covered by a current authorization -denied - provider can't bill patient for charges






16. Process of converting diagnoses - procedures - and services into numeric and alpha-numeric characters






17. Provider agrees to accept what insurance company approves as payment in full for the claim






18. Working diagnosis which is not yet est.






19. Authorization by a policyholder to allow a thrid-party payer to pay benefits to a health care provider






20. Traditional method ised by providers for submissions of charges to insurance companies -CMS 1500 -few plans accept encounter forms Medicare will only acccept CMS 1500`






21. The amount set by the carrier for the reimbursement of services






22. Process of looking over a cliam to assess payment amounts






23. Take what insurance pays






24. Durable Medical Equipment Regional Carrier






25. Take what insurance pays






26. Entity that recieves transmissions of claims from physicians offices - seperates claims by carriers and performs software edits to check errors -once completed claim is sent to proper insurance -physician pays fee for their services






27. Physician must obtain this number in order to practice within a state






28. Any procedure or service reported on insurance claim that is not listed in payer's master benefit list -results in denial -payers may be able tp recover charges






29. Agreement between the patoent and the physician regarding monthly installments to pay a bill






30. State based group of physicians working under government guideline to review cases and determine their appropriateness and quality of professional care






31. Company that translates electroinc transactions between the standard formats and code set required under HIPAA and nonstandard formats and code sets






32. Amount required by an insurance company that must be taken off a patient's acoount based on actual agreements and participation






33. Alternative to paper claims submitted to the third-party payer directly by the physician or through clearinghouse -paid faster and software has self-editing detects and reports entries may cause to be rejected






34. Breaking the account receivable amounts into portions for billing at a specific date of the month






35. When two companies work together to decided payment of benefits






36. Bundling edits by CMS to combine various component items with a major service or procedure






37. Reimbursement directly sent from payer to provider






38. Checking or tracing a claim sent to an insurance comapany to determine payment or processing status






39. Listing of diagnosis - procedures - and charges for a patients visit






40. 1. Blocks 1-13=patient info 2.Blocks 14-33=physicians info






41. Number is used instead of the individuals physician's number for the performing provider who is a member of a group practice that sybmits claims to insurance complanies under the group name






42. 1.Collect patients info 2.Verifying Insurance 3.Prepare the encounter form 4.Code the diagnosis and procedures 5.Review linkage and compliance 6.Calculate physicians charges 7.Prepare Claims 8.Transmit claims 9.payer adjudication 10.Follow up on reim






43. Deferred or delayed processing method for inputting data a retrieval at a later date






44. Amount required by an insurance company that must be taken off a patient's acoount based on actual agreements and participation






45. Electronic or paper-based report of payment sent by the payer to the provider






46. Physician must obtain this number in order to practice within a state






47. Specific time frames assigned to a code by an insurance comapny before additional payment will be made following a surgical procedure






48. Using ICD-9 codes to hughest degree






49. Fee that is charged for each procedure pr service performed by the physician -fee is obtained from a fee schedule - list of charges or allowance that have accepted for specific medical services






50. 1.Claims submission-transmission of claims data either electronically or manually to third party payers or clearinghouse for processing 2.Claims processing- thrid party payers and clearinghouse verify the information found and submitted claims about