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






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






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






4. 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






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






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






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






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






9. Listing service in their order of importance by dates of service and values. Highest charge to lowest charge






10. 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






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






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






13. Using ICD-9 codes to hughest degree






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






15. 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






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






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






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






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






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






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






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






23. When two companies work together to decided payment of benefits






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






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






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






27. The amount set by the carrier for the reimbursement of services






28. Combing lesser services with a major service in order for one charge to include that variety of service






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






30. 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






31. Federal Employees' Compensation Act






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






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






34. Superbill or Encounter Form






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






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






37. 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






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






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






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






41. Term for processing payment






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






43. 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






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






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






46. Durable Medical Equipment Regional Carrier






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






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






49. 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






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