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






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






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






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






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






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






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






8. Billing for each item service provided to a patient in accourdance with insurance carriers' policies






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






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






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






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






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






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






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






16. Percent of payment held back for a risk account in the HMO program






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






18. 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






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






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






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






22. 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`






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






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






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






26. Term for processing payment






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






28. Term for processing payment






29. Early and Periodic Screenings - Diagnosis - and Treatment






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






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






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






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






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






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






36. Federal Employees' Compensation Act






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






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






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






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






41. Assigned to the physician by Medicare program






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






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






44. 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






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






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






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






48. 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






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






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