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Test your basic knowledge |
Medical Billing Claims Basics
Start Test
Study First
Subject
:
medical-transcription
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. Take what insurance pays
TWIP
Itemized Statement
Appeal
Fiscal Intermediary (FI)
2. Promote interest and well being of the patients and residents of healthcare facility
V.I. Payment
The Patient Care Partnership(Patients Bill of Rights)
Coding
Truth in Lending
3. Physician must obtain this number in order to practice within a state
Ranking Code
Employer Indentification Number (EIN)
Universal Claim Form
State License Number
4. Passed by the federal government to prosecute cases of Medicaid fraud
Encounter Form(Superbill)
Civil Monetary Penalities Law (CMPL)
Life Cycle of Insurance Claims
Bundling
5. Patient who owes a balance on the account who has moved without a forwarding address
Utilization review
Skip
Assignment of Benefits
Medical Necessity Edit Checks
6. Process of assesing medical services to assure medical necessity and the appropriateness of treatment
Utilization review
Adjudicate
Assignment of Benefits
Suspended File Report
7. Codes used by insurance compaines to explain actions taken on a Remittance Notice
Coordination of Benefits (COB)
Itemized Statement
Adjustment Codes
Skip
8. Bundling edits by CMS to combine various component items with a major service or procedure
The Patient Care Partnership(Patients Bill of Rights)
Collection Ratio
Correct Coding Initiative (CCI)
Qualified Diagnosis
9. 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
Component Billing
Global Period
Group Practice
Clearinghouse
10. The amount set by the carrier for the reimbursement of services
Adjudicate
Fee Schedule
Adjustment
Allowed Charge
11. Specific time frames assigned to a code by an insurance comapny before additional payment will be made following a surgical procedure
Universal Claim Form
Global Period
Dun/Dunning
Basic Billing and Reimbursment Steps
12. Early and Periodic Screenings - Diagnosis - and Treatment
Withhold Incentive
EPSDT
Profile
Inquiry
13. Request or message to remind a patient that the account is over due or delinquent
TWIP
Performing Provider Identification Number(PPIN)
Open Account
Dun/Dunning
14. Physician has a seperate PPIN for each group/clinic in which they practices
Performing Provider Identification Number(PPIN)
Coordination of Benefits (COB)
Accepted Assignments
Life Cycle of Insurance Claims
15. Process or tansferring account information from a journal to a ledger
Ranking Code
Fee-for-Service
Posting
Qualified Diagnosis
16. Amount of time allowed by an insurance company for a claim to be submitted for a payment from the date of service
Adjustment
Conversion Factor
Suspended File Report
Timely Filing Clause
17. Percent of payment held back for a risk account in the HMO program
Withhold Incentive
Actual Charge
Encounter Form(Superbill)
Medical Necessity Edit Checks
18. Request or message to remind a patient that the account is over due or delinquent
State License Number
Dun/Dunning
Aging Accounts
Batching
19. 1. Blocks 1-13=patient info 2.Blocks 14-33=physicians info
Claim Form is divided into 2 sections
Timely Filing Clause
Explaination of Benefits
Exclusions and Limatations
20. Procedure or services provided without proper authorizationor was not covered by a current authorization -denied - provider can't bill patient for charges
Unarthorized Benefit
Allowed Charge
Medical Necessity
Allowed Charge
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
Actual Charge
Clearinghouse
Bundling
Group Practice
22. Process of converting diagnoses - procedures - and services into numeric and alpha-numeric characters
Commerical Payer
Paper Claims
Coding
Aging Report
23. Reimbursement directly sent from payer to provider
Withhold Incentive
Civil Monetary Penalities Law (CMPL)
Assignment of Benefits
Customary Charge
24. Major surgical procedures that typically have a follow-up period of 30 - 60 - 90 - 120 days
Commerical Payer
Claim Form is divided into 2 sections
Global Procedures
Explaination of Benefits
25. 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
Ranking Code
Explaination of Benefits
Fee-for-Service
Aging Report
26. Reimbursement directly sent from payer to provider
Component Billing
Assignment of Benefits
Basic Billing and Reimbursment Steps
DMERC
27. Private health insurance company or employer-based group insurance plan that pays claims for eligible participants
Civil Monetary Penalities Law (CMPL)
Ledger Card
Commerical Payer
Assignment of Benefits
28. 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
Performing Provider Identification Number(PPIN)
Adjustment
Health Care Clearinghouse
Global Procedures
29. Record to track patients charges - payments - adjustments - and balance due
Ledger Card
Remittance Advice(RA)
Health Care Clearinghouse
TWIP
30. Agreement between the patoent and the physician regarding monthly installments to pay a bill
Basic Billing and Reimbursment Steps
FECA
Truth in Lending
Customary Charge
31. Physician must obtain this number in order to practice within a state
Open Account
Correct Coding Initiative (CCI)
Conversion Factor
State License Number
32. 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
Clearinghouse
Medical Necessity Edit Checks
Non-Covered Benefits
Appeal
33. 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
Dun/Dunning
Medical Necessity Edit Checks
Provider Identification Number (PIN)
Component Billing
34. Request sent to an insurance comapany or other payer asking that a submitted claim be reconsidered for payment or processing
Appeal
Remittance Advice(RA)
Exclusions and Limatations
Employer Indentification Number (EIN)
35. Codes used by insurance compaines to explain actions taken on a Remittance Notice
Unique Provider Identification Number(UPIN)
Unit Count
Adjustment Codes
Skip
36. 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
Clearinghouse
Employer Indentification Number (EIN)
Timely Filing Clause
Actual Charge
37. Money amount determined by dividing the actual charge of a service or procedure by a relative unit
Conversion Factor
Bundling
Allowed Charge
DMERC
38. Procedure or services provided without proper authorizationor was not covered by a current authorization -denied - provider can't bill patient for charges
Utilization review
Unarthorized Benefit
Electronic Claim
Fiscal Intermediary (FI)
39. Electronic or paper-based report of payment sent by the payer to the provider
Electronic Claim
Encounter Form(Superbill)
Review
Remittance Advice(RA)
40. Electronic or paper-based report of payment sent by the payer to the provider
Adjustment Codes
Assignment
Batching
Remittance Advice(RA)
41. Early and Periodic Screenings - Diagnosis - and Treatment
EPSDT
Adjustment
V.I. Payment
Claim Form is divided into 2 sections
42. When two companies work together to decided payment of benefits
Paper Claims
Electronic Claim
Adjustment
Coordination of Benefits (COB)
43. 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`
Paper Claims
Provider Identification Number (PIN)
Coordination of Benefits (COB)
Skip
44. Established proce set by a medical practice for proefessional services
Fee Schedule
Allowed Charge
Truth in Lending
Ledger Card
45. Physician has a seperate PPIN for each group/clinic in which they practices
Medical Necessity Edit Checks
Aging Accounts
Performing Provider Identification Number(PPIN)
Allowed Charge
46. CMS 1500 - became effective July 2007 -All third party payers accept it - Medicare requires all physicians to use it
Open Account
Universal Claim Form
Peer Review Orginization (PRO)
Batching
47. 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
Unique Provider Identification Number(UPIN)
Actual Charge
Provider Identification Number (PIN)
Electronic Claim
48. A report to track claim status of patient accounts and to identify individual accounts requiring additional workup for payments or write-offs
Aging Report
Unique Provider Identification Number(UPIN)
Withhold Incentive
Profile
49. Combing lesser services with a major service in order for one charge to include that variety of service
Skip
Review
Assignment of Benefits
Bundling
50. Billing for each item service provided to a patient in accourdance with insurance carriers' policies
Professional Courtesy
Actual Charge
Performing Provider Identification Number(PPIN)
Component Billing