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. Reimbursement directly sent from payer to provider






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






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






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






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






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






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






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






9. Statement of a patient's account history - showing DOS - detailed chrages - payments - day insurance claims was submitted - applicable adjusments - and account balances






10. Take what insurance pays






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






12. 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






13. Term for processing payment






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






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






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






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






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






19. Superbill or Encounter Form






20. Statement of a patient's account history - showing DOS - detailed chrages - payments - day insurance claims was submitted - applicable adjusments - and account balances






21. Federal Employees' Compensation Act






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






23. 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






24. Term for processing payment






25. 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






26. Agreement between the patoent and the physician regarding monthly installments to pay a bill






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






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






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






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






31. 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'






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






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






34. 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






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






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






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






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






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






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






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






42. Using ICD-9 codes to hughest degree






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






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






45. 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






46. Early and Periodic Screenings - Diagnosis - and Treatment






47. Amount charged by a practice when providing services






48. 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






49. Established proce set by a medical practice for proefessional services






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