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






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






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






4. Durable Medical Equipment Regional Carrier






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






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






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






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






9. Superbill or Encounter Form






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






11. Superbill or Encounter Form






12. Reimbursement directly sent from payer to provider






13. Amount charged by a practice when providing services






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






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






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






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






18. 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






19. 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'






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






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






22. 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






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






24. Record to track patients charges - payments - adjustments - and balance due






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






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






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






28. Early and Periodic Screenings - Diagnosis - and Treatment






29. Durable Medical Equipment Regional Carrier






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






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






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






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






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






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






36. 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






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






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






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






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






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






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






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






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






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






46. 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






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






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






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






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