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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. Reimbursement directly sent from payer to provider






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






3. Superbill or Encounter Form






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






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






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






8. Take what insurance pays






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






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






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






12. Durable Medical Equipment Regional Carrier






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






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






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






16. 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






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






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






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






20. 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






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






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






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






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






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






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






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






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






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






30. 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






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






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






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






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






35. Request or message to remind a patient that the account is over due or delinquent






36. 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






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






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






39. 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'






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






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






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






43. 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






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






45. Working diagnosis which is not yet est.






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






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






48. Take what insurance pays






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






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







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