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






2. 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






3. Take what insurance pays






4. Reimbursement directly sent from payer to provider






5. Using ICD-9 codes to hughest degree






6. Analysis of accounts receivable that indicate delinquency of 60 - 90 - 120 days






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






8. Durable Medical Equipment Regional Carrier






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






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






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






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






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






14. 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






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






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






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






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






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






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






21. Term for processing payment






22. Working diagnosis which is not yet est.






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






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






25. 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






26. 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






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






28. Durable Medical Equipment Regional Carrier






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






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






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






32. 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`






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






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






35. Process of looking over a cliam to assess payment amounts






36. Superbill or Encounter Form






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






38. 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






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






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






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






42. 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






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






44. Analysis of accounts receivable that indicate delinquency of 60 - 90 - 120 days






45. Superbill or Encounter Form






46. 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






47. Federal Employees' Compensation Act






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






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






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