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






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






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






4. Durable Medical Equipment Regional Carrier






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






6. 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`






7. 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`






8. Analysis of accounts receivable that indicate delinquency of 60 - 90 - 120 days






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






10. 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'






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






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






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






14. Term for processing payment






15. Reimbursement directly sent from payer to provider






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






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






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






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






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






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






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






23. Amount charged by a practice when providing services






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






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






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






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






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






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






30. Term for processing payment






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






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






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






34. 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






35. 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






36. 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






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






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






39. 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






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






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






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






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






44. Amount charged by a practice when providing services






45. Federal Tax identification number - issued by internal revenue service -social security number used if employer doesn't have a EIN






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






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






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






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






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