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






2. 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`






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






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






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






6. Term for processing payment






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






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






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






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






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






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






13. 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






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






15. 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






16. Using ICD-9 codes to hughest degree






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






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






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






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






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






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






23. Assigned to the physician by Medicare program






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






25. 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






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






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






28. 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






29. Describes the service billed and includes a breakdown of how payment is determined






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






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. Assigned to the physician by Medicare program






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






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






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






36. Take what insurance pays






37. 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






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






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






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






41. Accounts that are subject to charges from time to time






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






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






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






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






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






47. 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






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






49. 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






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