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






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






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






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






5. Early and Periodic Screenings - Diagnosis - and Treatment






6. Using ICD-9 codes to hughest degree






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






8. 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






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






10. Federal Employees' Compensation Act






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






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






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






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






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






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






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






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






19. 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






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






21. 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






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






23. 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'






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






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






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






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






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






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






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






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






32. 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






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






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. 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`






36. Take what insurance pays






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






38. 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






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






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






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






42. 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






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






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






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






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






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






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






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






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