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






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






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






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






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






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






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






8. 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






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






10. Reimbursement directly sent from payer to provider






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






12. Superbill or Encounter Form






13. Assigned to the physician by Medicare program






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






15. Federal Employees' Compensation Act






16. Superbill or Encounter Form






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






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






19. 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






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






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






22. Take what insurance pays






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






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






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






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






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






28. 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'






29. Durable Medical Equipment Regional Carrier






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. Federal Employees' Compensation Act






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






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






35. 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






36. 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






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






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






39. Take what insurance pays






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






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






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






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






44. Durable Medical Equipment Regional Carrier






45. Term for processing payment






46. 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






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






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






49. Working diagnosis which is not yet est.






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







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