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






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






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






4. Take what insurance pays






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






6. Amount charged by a practice when providing services






7. Listing of claims that have incorrect information such as posting error or missing information to process a claim






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






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






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






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






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






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






14. Established proce set by a medical practice for proefessional services






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






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






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






18. 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






19. Working diagnosis which is not yet est.






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






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






22. 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






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






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






25. 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






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






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






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






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






30. The amount set by the carrier for the reimbursement of services






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






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






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






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






35. Term for processing payment






36. Using ICD-9 codes to hughest degree






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. 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`






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






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






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






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






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






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






46. Early and Periodic Screenings - Diagnosis - and Treatment






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






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






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






50. Federal Employees' Compensation Act