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






2. 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`






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






4. 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






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






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






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






8. Take what insurance pays






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






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






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






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






13. Superbill or Encounter Form






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






15. 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'






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






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






18. 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






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






20. 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






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






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






23. Early and Periodic Screenings - Diagnosis - and Treatment






24. 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






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






26. 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






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






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






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






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






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






32. 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'






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






34. Term for processing payment






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






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






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






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






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






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






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






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






43. Early and Periodic Screenings - Diagnosis - and Treatment






44. 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






45. 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






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






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






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






49. 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






50. 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