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






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






3. Assigned to the physician by Medicare program






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






5. 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






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






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






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






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






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






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






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






13. 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'






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






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






16. 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






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






18. 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






19. Using ICD-9 codes to hughest degree






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






21. Superbill or Encounter Form






22. Working diagnosis which is not yet est.






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






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






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






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






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






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






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






30. 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






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






32. 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






33. 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






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






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






36. 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






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






38. Take what insurance pays






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






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






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






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






43. 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






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






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






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






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






48. 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`






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






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







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