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






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






4. Using ICD-9 codes to hughest degree






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






6. Describes the service billed and includes a breakdown of how payment is determined






7. 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






8. CMS 1500 - became effective July 2007 -All third party payers accept it - Medicare requires all physicians to use it






9. Defined by Medicare as 'The determination that a service or procedure rendered is resonable and necessary for the diagnosis or treatment of an illness or injury'






10. Durable Medical Equipment Regional Carrier






11. List of CPT codes used by a physician with a corresponding fee that is usually calculated and maintained by a third-party payer






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






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






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






15. List of CPT codes used by a physician with a corresponding fee that is usually calculated and maintained by a third-party payer






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






17. Reimbursement directly sent from payer to provider






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






19. Assigned to the physician by Medicare program






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






21. Take what insurance pays






22. 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






23. Term for processing payment






24. 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






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






26. 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






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






28. Major surgical procedures that typically have a follow-up period of 30 - 60 - 90 - 120 days






29. Request sent to an insurance comapany or other payer asking that a submitted claim be reconsidered for payment or processing






30. Amount of time allowed by an insurance company for a claim to be submitted for a payment from the date of service






31. Means to report the number of times a service was provided on the same date of service to the same patient






32. 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






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






34. Process of assesing medical services to assure medical necessity and the appropriateness of treatment






35. Amount corrected on a patient ledger due to an error or a difference in the amount billed by a practice and the amount allowed by the insurance company






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






37. Process or tansferring account information from a journal to a ledger






38. Defined by Medicare as 'The determination that a service or procedure rendered is resonable and necessary for the diagnosis or treatment of an illness or injury'






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






40. Major surgical procedures that typically have a follow-up period of 30 - 60 - 90 - 120 days






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






42. Codes used by insurance compaines to explain actions taken on a Remittance Notice






43. Number assigned by insurance companies to a physician who renders service to patients






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






45. Term for processing payment






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






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






48. Insurance company that bids for a contract with CMS to handle the Medicare program in a specific area






49. Money amount determined by dividing the actual charge of a service or procedure by a relative unit






50. 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