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






2. 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






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






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






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






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






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






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






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






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






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






12. 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






13. 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






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






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






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






17. Early and Periodic Screenings - Diagnosis - and Treatment






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






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






20. 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`






21. Term for processing payment






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






23. 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'






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






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






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






27. Reimbursement directly sent from payer to provider






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






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






30. Federal Employees' Compensation Act






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






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






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






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






35. 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






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






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






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






39. Reimbursement directly sent from payer to provider






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






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. 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






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






44. Assigned to the physician by Medicare program






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






46. 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






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






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






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






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