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






2. Assigned to the physician by Medicare program






3. Early and Periodic Screenings - Diagnosis - and Treatment






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






5. Federal Tax identification number - issued by internal revenue service -social security number used if employer doesn't have a EIN






6. Amount charged by a practice when providing services






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






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






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






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






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






12. Federal Employees' Compensation Act






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






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






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






16. 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'






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






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






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






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






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






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






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






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






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






26. Electronic or paper-based report of payment sent by the payer to the provider






27. 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






28. Take what insurance pays






29. Amount of time allowed by an insurance company for a claim to be submitted for a payment from the date of service






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






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






32. Term for processing payment






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






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






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






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






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






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






39. 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`






40. 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






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






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






43. Reimbursement directly sent from payer to provider






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






45. 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






46. Federal Tax identification number - issued by internal revenue service -social security number used if employer doesn't have a EIN






47. Electronic or paper-based report of payment sent by the payer to the provider






48. Using ICD-9 codes to hughest degree






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






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