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






2. 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






3. 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






4. 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






5. Record to track patients charges - payments - adjustments - and balance due






6. Working diagnosis which is not yet est.






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






8. Federal Employees' Compensation Act






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






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






11. Durable Medical Equipment Regional Carrier






12. Assigned to the physician by Medicare program






13. 1. Blocks 1-13=patient info 2.Blocks 14-33=physicians info






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






15. 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






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






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






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






19. 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






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`






21. Passed by the federal government to prosecute cases of Medicaid fraud






22. Record to track patients charges - payments - adjustments - and balance due






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






24. 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






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






26. Specific time frames assigned to a code by an insurance comapny before additional payment will be made following a surgical procedure






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






28. Superbill or Encounter Form






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






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






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






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






33. Early and Periodic Screenings - Diagnosis - and Treatment






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






35. Assigned to the physician by Medicare program






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






37. 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






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






39. 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






40. 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






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






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






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






44. Take what insurance pays






45. 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






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






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






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






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






50. 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'