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






2. Authorization by a policyholder to allow a thrid-party payer to pay benefits to a health care provider






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






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






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






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






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






8. Superbill or Encounter Form






9. Procedure or services provided without proper authorizationor was not covered by a current authorization -denied - provider can't bill patient for charges






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






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






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






13. 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'






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






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






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






17. Procedure or services provided without proper authorizationor was not covered by a current authorization -denied - provider can't bill patient for charges






18. 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`






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






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






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






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






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






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






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






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






27. 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






28. Authorization by a policyholder to allow a thrid-party payer to pay benefits to a health care provider






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






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






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






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






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






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






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






36. Amount charged by a practice when providing services






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






38. Amount charged by a practice when providing services






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






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






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






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






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






44. Specific time frames assigned to a code by an insurance comapny before additional payment will be made following a surgical procedure






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






46. Reimbursement directly sent from payer to provider






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






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






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






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