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






2. 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






3. Federal Employees' Compensation Act






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






5. Term for processing payment






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






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






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






10. 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






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






12. Superbill or Encounter Form






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






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






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






16. 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`






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






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






19. 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'






20. Working diagnosis which is not yet est.






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






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






23. 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






24. Using ICD-9 codes to hughest degree






25. 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






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






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






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






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






30. Federal Employees' Compensation Act






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






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






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






34. Early and Periodic Screenings - Diagnosis - and Treatment






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






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






37. 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






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






39. 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






40. Take what insurance pays






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






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






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






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. Process of looking over a cliam to assess payment amounts






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






47. Early and Periodic Screenings - Diagnosis - and Treatment






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