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






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






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






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






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






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






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






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






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






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






11. Federal Employees' Compensation Act






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






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






14. 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`






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






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






17. Reimbursement directly sent from payer to provider






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






19. 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






20. Working diagnosis which is not yet est.






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






22. 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






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






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






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






26. Amount charged by a practice when providing services






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






28. 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`






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






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






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






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






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






34. 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






35. 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






36. 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






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






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






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






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






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






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






43. 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






44. Superbill or Encounter Form






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






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






47. 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






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






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






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