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. 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






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






3. Analysis of accounts receivable that indicate delinquency of 60 - 90 - 120 days






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






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






6. Accounts that are subject to charges from time to time






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






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






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






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






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






12. 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'






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






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






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






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






17. Early and Periodic Screenings - Diagnosis - and Treatment






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






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






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






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






22. 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






23. Amount representing the charge most frequently used by a physician in a given periord of time






24. Listing service in their order of importance by dates of service and values. Highest charge to lowest charge






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






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






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






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






29. Statement of a patient's account history - showing DOS - detailed chrages - payments - day insurance claims was submitted - applicable adjusments - and account balances






30. Relationship between the amount of money owed and the amount of money collected






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






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






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






34. 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






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






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






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






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






39. Federal Tax identification number - issued by internal revenue service -social security number used if employer doesn't have a EIN






40. Assigned to the physician by Medicare program






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






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






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






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






45. Once claim is approved for payment Remittance Advice(RA) is sent to the provider and EOB is mailed to the policyholder






46. Early and Periodic Screenings - Diagnosis - and Treatment






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






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






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






50. 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