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






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






3. 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






4. 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






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






6. 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






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






8. Assigned to the physician by Medicare program






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






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






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






12. Federal Employees' Compensation Act






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






14. Amount charged by a practice when providing services






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






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






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






18. Take what insurance pays






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






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






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






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






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






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






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






26. 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






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






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






29. Amount charged by a practice when providing services






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






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






32. 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






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






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






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






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






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






38. 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






39. 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






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






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






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






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






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






45. Working diagnosis which is not yet est.






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






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






48. 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`






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






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