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. 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






2. 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






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






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






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






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






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






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






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






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






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






12. Amount charged by a practice when providing services






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






14. 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






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






16. Durable Medical Equipment Regional Carrier






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






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






19. 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`






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






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






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






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






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






25. Term for processing payment






26. 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






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






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






29. Superbill or Encounter Form






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






31. Early and Periodic Screenings - Diagnosis - and Treatment






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






33. 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






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






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






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






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






39. 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'






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






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






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






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






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






45. Reimbursement directly sent from payer to provider






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






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






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






49. Superbill or Encounter Form






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