SUBJECTS
|
BROWSE
|
CAREER CENTER
|
POPULAR
|
JOIN
|
LOGIN
Business Skills
|
Soft Skills
|
Basic Literacy
|
Certifications
About
|
Help
|
Privacy
|
Terms
|
Email
Search
Test your basic knowledge |
Medical Billing Claims Basics
Start Test
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. 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
Adjustment
Assignment
TWIP
Paper Claims
2. Physician must obtain this number in order to practice within a state
Allowed Charge
Commerical Payer
Dun/Dunning
State License Number
3. Percent of payment held back for a risk account in the HMO program
Withhold Incentive
Electronic Claim
Fee-for-Service
Performing Provider Identification Number(PPIN)
4. Describes the service billed and includes a breakdown of how payment is determined
Commerical Payer
Life Cycle of Insurance Claims
Explaination of Benefits
Bundling
5. Money amount determined by dividing the actual charge of a service or procedure by a relative unit
Group Practice
Group Provider Number
Coordination of Benefits (COB)
Conversion Factor
6. State based group of physicians working under government guideline to review cases and determine their appropriateness and quality of professional care
Peer Review Orginization (PRO)
Medical Necessity
Group Practice
Actual Charge
7. Federal Tax identification number - issued by internal revenue service -social security number used if employer doesn't have a EIN
Employer Indentification Number (EIN)
Paper Claims
Skip
Withhold Incentive
8. 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
V.I. Payment
Claim Form is divided into 2 sections
Assignment
Medical Necessity Edit Checks
9. Once claim is approved for payment Remittance Advice(RA) is sent to the provider and EOB is mailed to the policyholder
V.I. Payment
Allowed Charge
Component Billing
FECA
10. Procedure or services provided without proper authorizationor was not covered by a current authorization -denied - provider can't bill patient for charges
TWIP
The Patient Care Partnership(Patients Bill of Rights)
Unarthorized Benefit
Non-Covered Benefits
11. Established proce set by a medical practice for proefessional services
Correct Coding Initiative (CCI)
Fee Schedule
Profile
Review
12. Codes used by insurance compaines to explain actions taken on a Remittance Notice
Adjustment Codes
Ranking Code
Professional Courtesy
Coding
13. 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
Basic Billing and Reimbursment Steps
Medical Necessity Edit Checks
Professional Courtesy
Performing Provider Identification Number(PPIN)
14. Process of assesing medical services to assure medical necessity and the appropriateness of treatment
Adjudicate
EPSDT
Utilization review
V.I. Payment
15. Conditions - situations - and services not covered by the insurance carrier
Qualified Diagnosis
Group Practice
Exclusions and Limatations
Universal Claim Form
16. Relationship between the amount of money owed and the amount of money collected
Dun/Dunning
Collection Ratio
Assignment
State License Number
17. Number assigned by insurance companies to a physician who renders service to patients
Paper Claims
Provider Identification Number (PIN)
Remittance Advice(RA)
Review
18. 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'
Suspended File Report
Bundling
Medical Necessity
Basic Billing and Reimbursment Steps
19. CMS 1500 - became effective July 2007 -All third party payers accept it - Medicare requires all physicians to use it
Universal Claim Form
Fee-for-Service
State License Number
Coordination of Benefits (COB)
20. Combing lesser services with a major service in order for one charge to include that variety of service
Exclusions and Limatations
State License Number
Bundling
Cycle Billing
21. Private health insurance company or employer-based group insurance plan that pays claims for eligible participants
Commerical Payer
Inquiry
Fee Schedule
Adjustment Codes
22. Promote interest and well being of the patients and residents of healthcare facility
The Patient Care Partnership(Patients Bill of Rights)
Employer Indentification Number (EIN)
Fee Slip
Actual Charge
23. Take what insurance pays
Explaination of Benefits
TWIP
Universal Claim Form
Profile
24. Amount charged by a practice when providing services
Assignment
Life Cycle of Insurance Claims
Review
Actual Charge
25. Assigned to the physician by Medicare program
Timely Filing Clause
Unique Provider Identification Number(UPIN)
State License Number
Batching
26. Superbill or Encounter Form
Peer Review Orginization (PRO)
Claim Form is divided into 2 sections
Truth in Lending
Fee Slip
27. Using ICD-9 codes to hughest degree
Open Account
Specificty
Unarthorized Benefit
Utilization review
28. Specific time frames assigned to a code by an insurance comapny before additional payment will be made following a surgical procedure
Electronic Claim
Global Period
Universal Claim Form
Itemized Statement
29. Early and Periodic Screenings - Diagnosis - and Treatment
Explaination of Benefits
Adjustment Codes
EPSDT
Basic Billing and Reimbursment Steps
30. Record to track patients charges - payments - adjustments - and balance due
Ledger Card
Customary Charge
Unarthorized Benefit
Life Cycle of Insurance Claims
31. 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
Non-Covered Benefits
State License Number
Suspended File Report
Provider Identification Number (PIN)
32. Established proce set by a medical practice for proefessional services
Unarthorized Benefit
Electronic Claim
Fee Schedule
Group Provider Number
33. Analysis of accounts receivable that indicate delinquency of 60 - 90 - 120 days
Fee Schedule
Utilization review
Aging Accounts
Peer Review Orginization (PRO)
34. 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`
Global Procedures
Paper Claims
FECA
Assignment of Benefits
35. 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`
Coordination of Benefits (COB)
Paper Claims
Non-Covered Benefits
Aging Accounts
36. A report to track claim status of patient accounts and to identify individual accounts requiring additional workup for payments or write-offs
Appeal
Fiscal Intermediary (FI)
Accepted Assignments
Aging Report
37. Deferred or delayed processing method for inputting data a retrieval at a later date
Batching
Medical Necessity Edit Checks
Skip
Adjudicate
38. Major surgical procedures that typically have a follow-up period of 30 - 60 - 90 - 120 days
Global Procedures
Fee-for-Service
Claim Form is divided into 2 sections
Withhold Incentive
39. Working diagnosis which is not yet est.
Fiscal Intermediary (FI)
Commerical Payer
Qualified Diagnosis
Customary Charge
40. Provider agrees to accept what insurance company approves as payment in full for the claim
Accepted Assignments
Civil Monetary Penalities Law (CMPL)
Conversion Factor
Specificty
41. Process of converting diagnoses - procedures - and services into numeric and alpha-numeric characters
Performing Provider Identification Number(PPIN)
V.I. Payment
Coding
Clearinghouse
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
Ledger Card
Adjustment
Fee-for-Service
EPSDT
43. Procedure or services provided without proper authorizationor was not covered by a current authorization -denied - provider can't bill patient for charges
Unarthorized Benefit
Electronic Claim
Ranking Code
Group Practice
44. The amount set by the carrier for the reimbursement of services
Fiscal Intermediary (FI)
Qualified Diagnosis
Global Period
Allowed Charge
45. Billing for each item service provided to a patient in accourdance with insurance carriers' policies
Component Billing
Review
Cycle Billing
Peer Review Orginization (PRO)
46. Number assigned by insurance companies to a physician who renders service to patients
Non-Covered Benefits
Provider Identification Number (PIN)
Withhold Incentive
Insurance Adjustment(write off)
47. Process of assesing medical services to assure medical necessity and the appropriateness of treatment
Batching
Cycle Billing
Utilization review
Electronic Claim
48. 1.Claims submission-transmission of claims data either electronically or manually to third party payers or clearinghouse for processing 2.Claims processing- thrid party payers and clearinghouse verify the information found and submitted claims about
Inquiry
Life Cycle of Insurance Claims
Profile
DMERC
49. Assigned to the physician by Medicare program
Adjustment
Medical Necessity Edit Checks
Life Cycle of Insurance Claims
Unique Provider Identification Number(UPIN)
50. 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
Remittance Advice(RA)
Group Practice
The Patient Care Partnership(Patients Bill of Rights)
Fee Schedule