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. Take what insurance pays






2. 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'






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






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






5. 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






6. 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






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






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






9. Amount charged by a practice when providing services






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






11. Superbill or Encounter Form






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






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






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






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






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






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






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






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






20. 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






21. Take what insurance pays






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






23. 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






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






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 converting diagnoses - procedures - and services into numeric and alpha-numeric characters






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






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






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






30. 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






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






32. Working diagnosis which is not yet est.






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






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






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






36. 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`






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






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






39. 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






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






41. 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'






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






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






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






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






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






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






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






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






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