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






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






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






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






5. 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






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






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






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






9. Take what insurance pays






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






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






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






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






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






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






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






17. Working diagnosis which is not yet est.






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






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






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






21. Record to track patients charges - payments - adjustments - and balance due






22. 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






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






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






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






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






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






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






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






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






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






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






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






34. Early and Periodic Screenings - Diagnosis - and Treatment






35. Assigned to the physician by Medicare program






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






37. Federal Employees' Compensation Act






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






39. 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






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






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






42. 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






43. Using ICD-9 codes to hughest degree






44. 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






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






46. Durable Medical Equipment Regional Carrier






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






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






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






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