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. Working diagnosis which is not yet est.






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






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






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






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






6. 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






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






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






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






10. 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






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






12. Using ICD-9 codes to hughest degree






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






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






15. Assigned to the physician by Medicare program






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






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






18. 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






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






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






21. 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






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






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






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






25. Amount charged by a practice when providing services






26. Superbill or Encounter Form






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






28. 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






29. 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






30. Superbill or Encounter Form






31. 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






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






33. Take what insurance pays






34. 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






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






36. Reimbursement directly sent from payer to provider






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






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






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






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






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






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






43. Term for processing payment






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






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






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






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






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






49. 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






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