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






2. 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'






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






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






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






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






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






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






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






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






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






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






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






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






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






16. Physician must obtain this number in order to practice within a state






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






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






19. Superbill or Encounter Form






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






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






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






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






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






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






26. 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






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






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






29. Amount representing the charge most frequently used by a physician in a given periord of time






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






31. Term for processing payment






32. Term for processing payment






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






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






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






36. Take what insurance pays






37. 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






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






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






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






41. Take what insurance pays






42. 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






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






44. 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`






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






46. Reimbursement directly sent from payer to provider






47. 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`






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






49. 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






50. Physician must obtain this number in order to practice within a state