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






2. 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






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






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






5. 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






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






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






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






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






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






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






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






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






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






15. 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'






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






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






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






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






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






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






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






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






24. 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






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






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






27. Amount charged by a practice when providing services






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






29. 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






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






31. 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






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






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






34. Working diagnosis which is not yet est.






35. Superbill or Encounter Form






36. 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






37. Federal Employees' Compensation Act






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






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






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






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






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






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






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






46. 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






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






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






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






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