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. 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






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






3. 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






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






5. 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






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






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






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






9. 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






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






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






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






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






14. 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






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






16. Using ICD-9 codes to hughest degree






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






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






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






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






21. 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






22. Reimbursement directly sent from payer to provider






23. Superbill or Encounter Form






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






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






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






27. Relationship between the amount of money owed and the amount of money collected






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






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






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






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






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






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






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






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






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






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






38. 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






39. Working diagnosis which is not yet est.






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






41. Reimbursement directly sent from payer to provider






42. 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






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






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






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






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






48. 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'






49. Superbill or Encounter Form






50. Take what insurance pays