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. Take what insurance pays






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






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






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






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






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






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






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






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






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






12. Early and Periodic Screenings - Diagnosis - and Treatment






13. Request or message to remind a patient that the account is over due or delinquent






14. Physician has a seperate PPIN for each group/clinic in which they practices






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






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






17. Percent of payment held back for a risk account in the HMO program






18. Request or message to remind a patient that the account is over due or delinquent






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






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






21. 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






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






23. Reimbursement directly sent from payer to provider






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






25. 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






26. Reimbursement directly sent from payer to provider






27. Private health insurance company or employer-based group insurance plan that pays claims for eligible participants






28. 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






29. Record to track patients charges - payments - adjustments - and balance due






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






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






32. 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






33. 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






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






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






36. 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






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






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






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






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






41. Early and Periodic Screenings - Diagnosis - and Treatment






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






43. 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`






44. Established proce set by a medical practice for proefessional services






45. Physician has a seperate PPIN for each group/clinic in which they practices






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






47. 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






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






49. Combing lesser services with a major service in order for one charge to include that variety of service






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