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






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






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






4. 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






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






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






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






8. Amount charged by a practice when providing services






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






10. Federal Employees' Compensation Act






11. Amount charged by a practice when providing services






12. 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'






13. Durable Medical Equipment Regional Carrier






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






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






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






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






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






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






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






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






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






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






24. 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






25. Number assigned by insurance companies to a physician who renders service to patients






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






27. 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






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






29. Early and Periodic Screenings - Diagnosis - and Treatment






30. Reimbursement directly sent from payer to provider






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






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






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






34. 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






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






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






37. 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






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






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






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






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






42. 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






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






44. 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






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






46. Established proce set by a medical practice for proefessional services






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






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






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






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