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. Using ICD-9 codes to hughest degree






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






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






4. Working diagnosis which is not yet est.






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






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






7. 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






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






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






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






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






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






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






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






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






16. 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'






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






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






19. 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






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






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






22. Durable Medical Equipment Regional Carrier






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






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






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






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






27. 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






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






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






30. Reimbursement directly sent from payer to provider






31. Take what insurance pays






32. Superbill or Encounter Form






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






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






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






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






37. Federal Employees' Compensation Act






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






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






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






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






42. 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`






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






44. 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






45. Assigned to the physician by Medicare program






46. 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






47. Working diagnosis which is not yet est.






48. Amount charged by a practice when providing services






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






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