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. Established proce set by a medical practice for proefessional services






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






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






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






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






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






7. 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'






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






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






10. 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






11. 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






12. Federal Employees' Compensation Act






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






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






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






16. 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






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






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






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






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






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






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






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






24. Term for processing payment






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






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






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






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






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






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






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






32. 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






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






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






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






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






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






38. Take what insurance pays






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






40. 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






41. 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






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






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






44. 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






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






46. 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






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






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






49. Reimbursement directly sent from payer to provider






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