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Test your basic knowledge |
Medical Billing Claims Basics
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Study First
Subject
:
medical-transcription
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. 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
Medical Necessity Edit Checks
State License Number
Actual Charge
Performing Provider Identification Number(PPIN)
2. Codes used by insurance compaines to explain actions taken on a Remittance Notice
V.I. Payment
Universal Claim Form
Adjustment Codes
Specificty
3. Specific time frames assigned to a code by an insurance comapny before additional payment will be made following a surgical procedure
Global Period
Life Cycle of Insurance Claims
Paper Claims
Inquiry
4. Working diagnosis which is not yet est.
Truth in Lending
Qualified Diagnosis
Component Billing
Actual Charge
5. Federal Tax identification number - issued by internal revenue service -social security number used if employer doesn't have a EIN
Conversion Factor
Review
Inquiry
Employer Indentification Number (EIN)
6. Breaking the account receivable amounts into portions for billing at a specific date of the month
Cycle Billing
Bundling
Batching
Exclusions and Limatations
7. 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
EPSDT
Professional Courtesy
Group Provider Number
Encounter Form(Superbill)
8. Amount charged by a practice when providing services
Actual Charge
Commerical Payer
Unarthorized Benefit
Inquiry
9. Physician has a seperate PPIN for each group/clinic in which they practices
Performing Provider Identification Number(PPIN)
Universal Claim Form
Explaination of Benefits
V.I. Payment
10. 1. Blocks 1-13=patient info 2.Blocks 14-33=physicians info
Claim Form is divided into 2 sections
Utilization review
Professional Courtesy
Global Procedures
11. Durable Medical Equipment Regional Carrier
DMERC
Remittance Advice(RA)
Ledger Card
Review
12. Process or tansferring account information from a journal to a ledger
V.I. Payment
Paper Claims
Open Account
Posting
13. Major surgical procedures that typically have a follow-up period of 30 - 60 - 90 - 120 days
Peer Review Orginization (PRO)
Group Practice
Global Procedures
Actual Charge
14. Reimbursement directly sent from payer to provider
Aging Report
Clearinghouse
Unarthorized Benefit
Assignment of Benefits
15. Listing of diagnosis - procedures - and charges for a patients visit
Encounter Form(Superbill)
Aging Accounts
The Patient Care Partnership(Patients Bill of Rights)
Component Billing
16. Amount charged by a practice when providing services
Timely Filing Clause
Posting
Actual Charge
Bundling
17. Insurance company that bids for a contract with CMS to handle the Medicare program in a specific area
Medical Necessity
Health Care Clearinghouse
Fiscal Intermediary (FI)
DMERC
18. 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
Non-Covered Benefits
Actual Charge
Batching
Fee-for-Service
19. Established proce set by a medical practice for proefessional services
EPSDT
Customary Charge
Posting
Fee Schedule
20. Analysis of accounts receivable that indicate delinquency of 60 - 90 - 120 days
Ledger Card
Bundling
Aging Accounts
Utilization review
21. 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
The Patient Care Partnership(Patients Bill of Rights)
Ranking Code
Inquiry
Clearinghouse
22. Promote interest and well being of the patients and residents of healthcare facility
Life Cycle of Insurance Claims
The Patient Care Partnership(Patients Bill of Rights)
Medical Necessity Edit Checks
Suspended File Report
23. Statement of a patient's account history - showing DOS - detailed chrages - payments - day insurance claims was submitted - applicable adjusments - and account balances
Inquiry
Itemized Statement
Actual Charge
Withhold Incentive
24. Bundling edits by CMS to combine various component items with a major service or procedure
Correct Coding Initiative (CCI)
Posting
Group Provider Number
Profile
25. Conditions - situations - and services not covered by the insurance carrier
Exclusions and Limatations
Encounter Form(Superbill)
Accepted Assignments
Adjudicate
26. Means to report the number of times a service was provided on the same date of service to the same patient
Commerical Payer
Clearinghouse
Unit Count
Employer Indentification Number (EIN)
27. Process of assesing medical services to assure medical necessity and the appropriateness of treatment
Utilization review
Global Period
Withhold Incentive
Suspended File Report
28. Checking or tracing a claim sent to an insurance comapany to determine payment or processing status
Inquiry
Ranking Code
Truth in Lending
Accepted Assignments
29. Using ICD-9 codes to hughest degree
Dun/Dunning
Specificty
Non-Covered Benefits
Fee-for-Service
30. Major surgical procedures that typically have a follow-up period of 30 - 60 - 90 - 120 days
Unit Count
State License Number
Qualified Diagnosis
Global Procedures
31. Authorization by a policyholder to allow a thrid-party payer to pay benefits to a health care provider
Truth in Lending
Fee-for-Service
Assignment
Coordination of Benefits (COB)
32. Conditions - situations - and services not covered by the insurance carrier
Truth in Lending
Itemized Statement
Exclusions and Limatations
Remittance Advice(RA)
33. Assigned to the physician by Medicare program
Electronic Claim
Ledger Card
Unique Provider Identification Number(UPIN)
Fee Slip
34. Using ICD-9 codes to hughest degree
Withhold Incentive
Specificty
Medical Necessity Edit Checks
Civil Monetary Penalities Law (CMPL)
35. Working diagnosis which is not yet est.
EPSDT
Qualified Diagnosis
Timely Filing Clause
Itemized Statement
36. 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'
Component Billing
Unique Provider Identification Number(UPIN)
Medical Necessity
Withhold Incentive
37. Listing service in their order of importance by dates of service and values. Highest charge to lowest charge
Performing Provider Identification Number(PPIN)
Cycle Billing
Ranking Code
Insurance Adjustment(write off)
38. Process of looking over a cliam to assess payment amounts
Bundling
V.I. Payment
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Review
39. Billing for each item service provided to a patient in accourdance with insurance carriers' policies
Adjudicate
Component Billing
Accepted Assignments
Medical Necessity
40. Private health insurance company or employer-based group insurance plan that pays claims for eligible participants
Customary Charge
Commerical Payer
Unarthorized Benefit
Coordination of Benefits (COB)
41. 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
EPSDT
Electronic Claim
Universal Claim Form
Timely Filing Clause
42. 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
Encounter Form(Superbill)
Non-Covered Benefits
Correct Coding Initiative (CCI)
Basic Billing and Reimbursment Steps
43. 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
Utilization review
Fee-for-Service
Component Billing
Performing Provider Identification Number(PPIN)
44. Amount representing the charge most frequently used by a physician in a given periord of time
Customary Charge
Dun/Dunning
Adjustment
Unit Count
45. Specific time frames assigned to a code by an insurance comapny before additional payment will be made following a surgical procedure
Fee Slip
Global Period
Provider Identification Number (PIN)
Correct Coding Initiative (CCI)
46. Take what insurance pays
Coding
TWIP
Batching
Coordination of Benefits (COB)
47. Codes used by insurance compaines to explain actions taken on a Remittance Notice
Claim Form is divided into 2 sections
Adjustment Codes
Utilization review
Group Provider Number
48. A report to track claim status of patient accounts and to identify individual accounts requiring additional workup for payments or write-offs
Aging Report
Suspended File Report
Withhold Incentive
Adjudicate
49. 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`
Paper Claims
Unique Provider Identification Number(UPIN)
EPSDT
Bundling
50. State based group of physicians working under government guideline to review cases and determine their appropriateness and quality of professional care
Unique Provider Identification Number(UPIN)
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Peer Review Orginization (PRO)
Claim Form is divided into 2 sections