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






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






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






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






5. Using ICD-9 codes to hughest degree






6. 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






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






8. 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'






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






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






11. Amount charged by a practice when providing services






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






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






14. 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






15. 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






16. 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






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






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






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






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






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






23. 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'






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






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






26. 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






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






28. Assigned to the physician by Medicare program






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






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






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






32. 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






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






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






35. Term for processing payment






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






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






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






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






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






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






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






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






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






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






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






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






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






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






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