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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. Combing lesser services with a major service in order for one charge to include that variety of service
Correct Coding Initiative (CCI)
Universal Claim Form
Skip
Bundling
2. Using ICD-9 codes to hughest degree
DMERC
Specificty
Basic Billing and Reimbursment Steps
Appeal
3. Reimbursement directly sent from payer to provider
Fee Slip
Life Cycle of Insurance Claims
Assignment of Benefits
Qualified Diagnosis
4. 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
Utilization review
State License Number
Adjustment
Itemized Statement
5. CMS 1500 - became effective July 2007 -All third party payers accept it - Medicare requires all physicians to use it
Provider Identification Number (PIN)
Unarthorized Benefit
Professional Courtesy
Universal Claim Form
6. Process of converting diagnoses - procedures - and services into numeric and alpha-numeric characters
Specificty
Coding
Actual Charge
Allowed Charge
7. Discount or fee exception given to a patient at the discretion of the physician
Professional Courtesy
Adjustment
Paper Claims
Posting
8. Early and Periodic Screenings - Diagnosis - and Treatment
EPSDT
Coding
Group Provider Number
Peer Review Orginization (PRO)
9. 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
Medical Necessity
Medical Necessity Edit Checks
Global Procedures
Adjustment Codes
10. Record to track patients charges - payments - adjustments - and balance due
Ledger Card
The Patient Care Partnership(Patients Bill of Rights)
Performing Provider Identification Number(PPIN)
Life Cycle of Insurance Claims
11. State based group of physicians working under government guideline to review cases and determine their appropriateness and quality of professional care
V.I. Payment
Claim Form is divided into 2 sections
Peer Review Orginization (PRO)
Provider Identification Number (PIN)
12. Deferred or delayed processing method for inputting data a retrieval at a later date
Specificty
Exclusions and Limatations
Coordination of Benefits (COB)
Batching
13. Take what insurance pays
Global Procedures
Profile
TWIP
Truth in Lending
14. Accounts that are subject to charges from time to time
Encounter Form(Superbill)
Coordination of Benefits (COB)
Open Account
FECA
15. Billing for each item service provided to a patient in accourdance with insurance carriers' policies
Component Billing
Allowed Charge
Fee Schedule
Inquiry
16. Authorization by a policyholder to allow a thrid-party payer to pay benefits to a health care provider
Assignment
Truth in Lending
Truth in Lending
Health Care Clearinghouse
17. Accounts that are subject to charges from time to time
Open Account
Group Practice
Explaination of Benefits
Component Billing
18. Request or message to remind a patient that the account is over due or delinquent
Appeal
Coordination of Benefits (COB)
Dun/Dunning
Group Practice
19. 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
Provider Identification Number (PIN)
Group Provider Number
Conversion Factor
Ledger Card
20. Means to report the number of times a service was provided on the same date of service to the same patient
Aging Accounts
Unit Count
Assignment of Benefits
Coding
21. Authorization by a policyholder to allow a thrid-party payer to pay benefits to a health care provider
Inquiry
Life Cycle of Insurance Claims
Inquiry
Assignment
22. 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
Fee Slip
Adjustment
Peer Review Orginization (PRO)
Group Practice
23. A report to track claim status of patient accounts and to identify individual accounts requiring additional workup for payments or write-offs
Aging Report
Open Account
Claim Form is divided into 2 sections
Allowed Charge
24. Amount required by an insurance company that must be taken off a patient's acoount based on actual agreements and participation
Medical Necessity Edit Checks
Insurance Adjustment(write off)
Utilization review
Posting
25. Specific time frames assigned to a code by an insurance comapny before additional payment will be made following a surgical procedure
Provider Identification Number (PIN)
Global Period
Adjustment Codes
Provider Identification Number (PIN)
26. 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'
DMERC
Assignment of Benefits
Medical Necessity
Itemized Statement
27. Private health insurance company or employer-based group insurance plan that pays claims for eligible participants
Commerical Payer
Universal Claim Form
Withhold Incentive
Medical Necessity
28. Electronic or paper-based report of payment sent by the payer to the provider
Global Period
Unique Provider Identification Number(UPIN)
Remittance Advice(RA)
Clearinghouse
29. Analysis of accounts receivable that indicate delinquency of 60 - 90 - 120 days
Aging Accounts
Coordination of Benefits (COB)
Insurance Adjustment(write off)
Adjustment Codes
30. 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
Aging Report
Unit Count
Adjustment
Medical Necessity Edit Checks
31. Agreement between the patoent and the physician regarding monthly installments to pay a bill
EPSDT
Accepted Assignments
Peer Review Orginization (PRO)
Truth in Lending
32. Federal Tax identification number - issued by internal revenue service -social security number used if employer doesn't have a EIN
Ranking Code
Customary Charge
Employer Indentification Number (EIN)
Skip
33. Process of looking over a cliam to assess payment amounts
Review
TWIP
Global Procedures
Cycle Billing
34. Request sent to an insurance comapany or other payer asking that a submitted claim be reconsidered for payment or processing
Appeal
Unique Provider Identification Number(UPIN)
Global Period
Conversion Factor
35. Term for processing payment
V.I. Payment
Aging Report
Adjudicate
Cycle Billing
36. Describes the service billed and includes a breakdown of how payment is determined
Explaination of Benefits
Profile
Customary Charge
Electronic Claim
37. 1.Collect patients info 2.Verifying Insurance 3.Prepare the encounter form 4.Code the diagnosis and procedures 5.Review linkage and compliance 6.Calculate physicians charges 7.Prepare Claims 8.Transmit claims 9.payer adjudication 10.Follow up on reim
Conversion Factor
Basic Billing and Reimbursment Steps
Clearinghouse
Paper Claims
38. Statement of a patient's account history - showing DOS - detailed chrages - payments - day insurance claims was submitted - applicable adjusments - and account balances
Insurance Adjustment(write off)
Unarthorized Benefit
Itemized Statement
Non-Covered Benefits
39. 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
Exclusions and Limatations
Electronic Claim
Group Provider Number
Actual Charge
40. Codes used by insurance compaines to explain actions taken on a Remittance Notice
Review
Global Period
V.I. Payment
Adjustment Codes
41. Breaking the account receivable amounts into portions for billing at a specific date of the month
Cycle Billing
Professional Courtesy
Conversion Factor
Component Billing
42. Provider agrees to accept what insurance company approves as payment in full for the claim
Accepted Assignments
Collection Ratio
Suspended File Report
FECA
43. Request or message to remind a patient that the account is over due or delinquent
Coordination of Benefits (COB)
Dun/Dunning
Ledger Card
Global Period
44. Number assigned by insurance companies to a physician who renders service to patients
Utilization review
Allowed Charge
Provider Identification Number (PIN)
Remittance Advice(RA)
45. Money amount determined by dividing the actual charge of a service or procedure by a relative unit
Global Period
Fee Slip
Conversion Factor
Aging Report
46. 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
Employer Indentification Number (EIN)
Life Cycle of Insurance Claims
Commerical Payer
Suspended File Report
47. Listing service in their order of importance by dates of service and values. Highest charge to lowest charge
Ranking Code
Itemized Statement
Component Billing
Clearinghouse
48. Amount charged by a practice when providing services
Civil Monetary Penalities Law (CMPL)
Coding
Fee Schedule
Actual Charge
49. A report to track claim status of patient accounts and to identify individual accounts requiring additional workup for payments or write-offs
Aging Report
Timely Filing Clause
Employer Indentification Number (EIN)
Ledger Card
50. Billing for each item service provided to a patient in accourdance with insurance carriers' policies
Component Billing
Review
Suspended File Report
Peer Review Orginization (PRO)