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






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






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






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






5. Using ICD-9 codes to hughest degree






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






7. 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'






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






9. Take what insurance pays






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






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






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






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






14. Using ICD-9 codes to hughest degree






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






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






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






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






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






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






21. Term for processing payment






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






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






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






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






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






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






28. Amount charged by a practice when providing services






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






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






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






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






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






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






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






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






37. Fee that is charged for each procedure pr service performed by the physician -fee is obtained from a fee schedule - list of charges or allowance that have accepted for specific medical services






38. Assigned to the physician by Medicare program






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






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






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






42. Federal Employees' Compensation Act






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






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






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






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






47. Take what insurance pays






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






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






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