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






2. Take what insurance pays






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






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






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






6. 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






7. Process of assesing medical services to assure medical necessity and the appropriateness of treatment






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






9. 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






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






11. Federal Employees' Compensation Act






12. 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






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






14. Superbill or Encounter Form






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






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






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






18. Codes used by insurance compaines to explain actions taken on a Remittance Notice






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






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






21. 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






22. 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






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






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






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






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






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






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






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






30. 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






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






32. Codes used by insurance compaines to explain actions taken on a Remittance Notice






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






34. Conditions - situations - and services not covered by the insurance carrier






35. 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'






36. Durable Medical Equipment Regional Carrier






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






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






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






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






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






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






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






44. 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






45. Working diagnosis which is not yet est.






46. 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`






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






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






49. 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






50. 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