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. 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






2. Number assigned by insurance companies to a physician who renders service to patients






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






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






5. 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






6. Once claim is approved for payment Remittance Advice(RA) is sent to the provider and EOB is mailed to the policyholder






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






8. Private health insurance company or employer-based group insurance plan that pays claims for eligible participants






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






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






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






12. Using ICD-9 codes to hughest degree






13. 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






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






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






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






17. Process or tansferring account information from a journal to a ledger






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






19. Process or tansferring account information from a journal to a ledger






20. 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






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






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






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






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






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






26. Early and Periodic Screenings - Diagnosis - and Treatment






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






28. Amount charged by a practice when providing services






29. Amount charged by a practice when providing services






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






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






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






33. Durable Medical Equipment Regional Carrier






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






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






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






37. 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






38. Conditions - situations - and services not covered by the insurance carrier






39. 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






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






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






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






43. 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






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






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






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






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






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






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






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