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






2. 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






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






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






5. Take what insurance pays






6. Superbill or Encounter Form






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






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






9. 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'






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






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






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






13. Assigned to the physician by Medicare program






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






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






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






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






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






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






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






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






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






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






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






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






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






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






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






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






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






31. 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






32. Take what insurance pays






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






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






35. 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






36. Early and Periodic Screenings - Diagnosis - and Treatment






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






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






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






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






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






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






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






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






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






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






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






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






49. 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`






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