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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. Bundling edits by CMS to combine various component items with a major service or procedure
Correct Coding Initiative (CCI)
Conversion Factor
Insurance Adjustment(write off)
Unarthorized Benefit
2. 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
Actual Charge
Group Practice
Civil Monetary Penalities Law (CMPL)
Correct Coding Initiative (CCI)
3. Provider agrees to accept what insurance company approves as payment in full for the claim
V.I. Payment
Adjudicate
Posting
Accepted Assignments
4. Electronic or paper-based report of payment sent by the payer to the provider
Health Care Clearinghouse
Component Billing
Inquiry
Remittance Advice(RA)
5. Codes used by insurance compaines to explain actions taken on a Remittance Notice
TWIP
Adjustment Codes
Universal Claim Form
Suspended File Report
6. List of CPT codes used by a physician with a corresponding fee that is usually calculated and maintained by a third-party payer
Fee Slip
Qualified Diagnosis
Ranking Code
Profile
7. Procedure or services provided without proper authorizationor was not covered by a current authorization -denied - provider can't bill patient for charges
FECA
DMERC
Posting
Unarthorized Benefit
8. Agreement between the patoent and the physician regarding monthly installments to pay a bill
TWIP
Assignment of Benefits
Truth in Lending
Provider Identification Number (PIN)
9. Accounts that are subject to charges from time to time
Assignment of Benefits
Open Account
Inquiry
Adjustment
10. Established proce set by a medical practice for proefessional services
Fee Schedule
Fiscal Intermediary (FI)
The Patient Care Partnership(Patients Bill of Rights)
Appeal
11. Patient who owes a balance on the account who has moved without a forwarding address
Assignment of Benefits
Skip
Health Care Clearinghouse
Truth in Lending
12. 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
Truth in Lending
Fee Schedule
Suspended File Report
Medical Necessity Edit Checks
13. 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
Profile
Employer Indentification Number (EIN)
Adjustment
Unit Count
14. Physician has a seperate PPIN for each group/clinic in which they practices
Correct Coding Initiative (CCI)
Performing Provider Identification Number(PPIN)
Claim Form is divided into 2 sections
Truth in Lending
15. Amount required by an insurance company that must be taken off a patient's acoount based on actual agreements and participation
Collection Ratio
Skip
Insurance Adjustment(write off)
Exclusions and Limatations
16. Authorization by a policyholder to allow a thrid-party payer to pay benefits to a health care provider
Assignment of Benefits
Assignment
Encounter Form(Superbill)
Insurance Adjustment(write off)
17. Early and Periodic Screenings - Diagnosis - and Treatment
EPSDT
The Patient Care Partnership(Patients Bill of Rights)
Insurance Adjustment(write off)
Open Account
18. Request sent to an insurance comapany or other payer asking that a submitted claim be reconsidered for payment or processing
Medical Necessity
Appeal
Allowed Charge
Bundling
19. Patient who owes a balance on the account who has moved without a forwarding address
Fee Schedule
V.I. Payment
Skip
Basic Billing and Reimbursment Steps
20. 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`
Medical Necessity
Professional Courtesy
Paper Claims
Encounter Form(Superbill)
21. Term for processing payment
Peer Review Orginization (PRO)
Adjudicate
Truth in Lending
Performing Provider Identification Number(PPIN)
22. Money amount determined by dividing the actual charge of a service or procedure by a relative unit
Adjudicate
Provider Identification Number (PIN)
Life Cycle of Insurance Claims
Conversion Factor
23. 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'
Medical Necessity
Paper Claims
Dun/Dunning
The Patient Care Partnership(Patients Bill of Rights)
24. Billing for each item service provided to a patient in accourdance with insurance carriers' policies
Encounter Form(Superbill)
Component Billing
TWIP
Health Care Clearinghouse
25. Request sent to an insurance comapany or other payer asking that a submitted claim be reconsidered for payment or processing
Skip
Appeal
Health Care Clearinghouse
Truth in Lending
26. Request or message to remind a patient that the account is over due or delinquent
Ledger Card
Adjustment
Review
Dun/Dunning
27. Reimbursement directly sent from payer to provider
Unarthorized Benefit
Actual Charge
Professional Courtesy
Assignment of Benefits
28. Amount of time allowed by an insurance company for a claim to be submitted for a payment from the date of service
Ranking Code
Group Provider Number
Explaination of Benefits
Timely Filing Clause
29. Record to track patients charges - payments - adjustments - and balance due
Dun/Dunning
Profile
Insurance Adjustment(write off)
Ledger Card
30. Federal Employees' Compensation Act
Group Provider Number
Non-Covered Benefits
Profile
FECA
31. Amount of time allowed by an insurance company for a claim to be submitted for a payment from the date of service
Insurance Adjustment(write off)
Unique Provider Identification Number(UPIN)
Exclusions and Limatations
Timely Filing Clause
32. Statement of a patient's account history - showing DOS - detailed chrages - payments - day insurance claims was submitted - applicable adjusments - and account balances
Adjustment
Electronic Claim
Professional Courtesy
Itemized Statement
33. Listing of claims that have incorrect information such as posting error or missing information to process a claim
Truth in Lending
Suspended File Report
Health Care Clearinghouse
Open Account
34. Means to report the number of times a service was provided on the same date of service to the same patient
Withhold Incentive
Insurance Adjustment(write off)
EPSDT
Unit Count
35. 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
FECA
Group Practice
Profile
Civil Monetary Penalities Law (CMPL)
36. Listing of diagnosis - procedures - and charges for a patients visit
Performing Provider Identification Number(PPIN)
Allowed Charge
Encounter Form(Superbill)
Timely Filing Clause
37. Codes used by insurance compaines to explain actions taken on a Remittance Notice
Assignment
Insurance Adjustment(write off)
Adjustment Codes
Batching
38. CMS 1500 - became effective July 2007 -All third party payers accept it - Medicare requires all physicians to use it
Appeal
Assignment
Batching
Universal Claim Form
39. Reimbursement directly sent from payer to provider
Universal Claim Form
Group Provider Number
Ranking Code
Assignment of Benefits
40. Once claim is approved for payment Remittance Advice(RA) is sent to the provider and EOB is mailed to the policyholder
V.I. Payment
Withhold Incentive
Explaination of Benefits
Cycle Billing
41. 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
Timely Filing Clause
Basic Billing and Reimbursment Steps
Exclusions and Limatations
Truth in Lending
42. 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
Assignment
Fee-for-Service
Review
Adjustment
43. Combing lesser services with a major service in order for one charge to include that variety of service
Component Billing
Bundling
Peer Review Orginization (PRO)
Electronic Claim
44. Assigned to the physician by Medicare program
Electronic Claim
Conversion Factor
Unique Provider Identification Number(UPIN)
Allowed Charge
45. Passed by the federal government to prosecute cases of Medicaid fraud
Civil Monetary Penalities Law (CMPL)
Fee Slip
Unique Provider Identification Number(UPIN)
Basic Billing and Reimbursment Steps
46. 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
Adjustment
Medical Necessity
Itemized Statement
Medical Necessity Edit Checks
47. Listing service in their order of importance by dates of service and values. Highest charge to lowest charge
Unique Provider Identification Number(UPIN)
Qualified Diagnosis
Conversion Factor
Ranking Code
48. Listing service in their order of importance by dates of service and values. Highest charge to lowest charge
Ranking Code
Group Provider Number
Profile
Life Cycle of Insurance Claims
49. Describes the service billed and includes a breakdown of how payment is determined
Review
Fee Schedule
Global Procedures
Explaination of Benefits
50. When two companies work together to decided payment of benefits
Insurance Adjustment(write off)
Basic Billing and Reimbursment Steps
Health Care Clearinghouse
Coordination of Benefits (COB)