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






2. Working diagnosis which is not yet est.






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






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






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






6. Money amount determined by dividing the actual charge of a service or procedure by a relative unit






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






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






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






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






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






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






13. 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






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






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






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






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






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






19. 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






20. Reimbursement directly sent from payer to provider






21. 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






22. Amount charged by a practice when providing services






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






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






25. 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






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






27. 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






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






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






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






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






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






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






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






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






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






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






40. Superbill or Encounter Form






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






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






43. Superbill or Encounter Form






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






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






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






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






48. 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






49. 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






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