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Test your basic knowledge |
Medical Billing Claims Basics
Start Test
Study First
Subject
:
medical-transcription
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
The Patient Care Partnership(Patients Bill of Rights)
Electronic Claim
Truth in Lending
Insurance Adjustment(write off)
2. Billing for each item service provided to a patient in accourdance with insurance carriers' policies
Component Billing
Adjustment
Aging Accounts
Professional Courtesy
3. Process of converting diagnoses - procedures - and services into numeric and alpha-numeric characters
State License Number
Coding
Cycle Billing
The Patient Care Partnership(Patients Bill of Rights)
4. Money amount determined by dividing the actual charge of a service or procedure by a relative unit
Conversion Factor
Timely Filing Clause
Coordination of Benefits (COB)
Bundling
5. Amount representing the charge most frequently used by a physician in a given periord of time
Cycle Billing
Customary Charge
Component Billing
Qualified Diagnosis
6. Request or message to remind a patient that the account is over due or delinquent
Dun/Dunning
Accepted Assignments
Employer Indentification Number (EIN)
Truth in Lending
7. Money amount determined by dividing the actual charge of a service or procedure by a relative unit
Electronic Claim
Conversion Factor
Specificty
Batching
8. Early and Periodic Screenings - Diagnosis - and Treatment
Batching
EPSDT
Customary Charge
Peer Review Orginization (PRO)
9. Billing for each item service provided to a patient in accourdance with insurance carriers' policies
Component Billing
Actual Charge
Claim Form is divided into 2 sections
Insurance Adjustment(write off)
10. Means to report the number of times a service was provided on the same date of service to the same patient
Remittance Advice(RA)
Universal Claim Form
Unit Count
Life Cycle of Insurance Claims
11. Major surgical procedures that typically have a follow-up period of 30 - 60 - 90 - 120 days
Medical Necessity Edit Checks
Global Procedures
Cycle Billing
Exclusions and Limatations
12. Promote interest and well being of the patients and residents of healthcare facility
Exclusions and Limatations
Electronic Claim
The Patient Care Partnership(Patients Bill of Rights)
Explaination of Benefits
13. Discount or fee exception given to a patient at the discretion of the physician
Universal Claim Form
Skip
Professional Courtesy
V.I. Payment
14. Request sent to an insurance comapany or other payer asking that a submitted claim be reconsidered for payment or processing
Posting
Appeal
Correct Coding Initiative (CCI)
V.I. Payment
15. Working diagnosis which is not yet est.
Coding
Professional Courtesy
Actual Charge
Qualified Diagnosis
16. Patient who owes a balance on the account who has moved without a forwarding address
Skip
Basic Billing and Reimbursment Steps
FECA
Group Provider Number
17. State based group of physicians working under government guideline to review cases and determine their appropriateness and quality of professional care
Peer Review Orginization (PRO)
EPSDT
Claim Form is divided into 2 sections
Commerical Payer
18. 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'
Encounter Form(Superbill)
Assignment of Benefits
Medical Necessity
Universal Claim Form
19. Breaking the account receivable amounts into portions for billing at a specific date of the month
Cycle Billing
Fee Slip
Adjudicate
Qualified Diagnosis
20. Provider agrees to accept what insurance company approves as payment in full for the claim
Medical Necessity Edit Checks
Accepted Assignments
Adjudicate
Universal Claim Form
21. Physician must obtain this number in order to practice within a state
Global Procedures
Clearinghouse
Withhold Incentive
State License Number
22. Process or tansferring account information from a journal to a ledger
Qualified Diagnosis
Cycle Billing
Group Provider Number
Posting
23. Process of looking over a cliam to assess payment amounts
Performing Provider Identification Number(PPIN)
Review
Commerical Payer
Skip
24. 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
Group Provider Number
Commerical Payer
Fee-for-Service
Appeal
25. Process of assesing medical services to assure medical necessity and the appropriateness of treatment
Unit Count
Claim Form is divided into 2 sections
Withhold Incentive
Utilization review
26. Superbill or Encounter Form
Fee Slip
Adjustment Codes
Life Cycle of Insurance Claims
Posting
27. Promote interest and well being of the patients and residents of healthcare facility
Fee Slip
Cycle Billing
The Patient Care Partnership(Patients Bill of Rights)
Batching
28. Assigned to the physician by Medicare program
Review
Adjudicate
Unique Provider Identification Number(UPIN)
DMERC
29. Federal Tax identification number - issued by internal revenue service -social security number used if employer doesn't have a EIN
Employer Indentification Number (EIN)
Allowed Charge
Cycle Billing
V.I. Payment
30. Deferred or delayed processing method for inputting data a retrieval at a later date
Group Provider Number
Global Procedures
Batching
Cycle Billing
31. A report to track claim status of patient accounts and to identify individual accounts requiring additional workup for payments or write-offs
Customary Charge
Aging Report
EPSDT
Adjudicate
32. Listing service in their order of importance by dates of service and values. Highest charge to lowest charge
Medical Necessity
Ranking Code
Claim Form is divided into 2 sections
Clearinghouse
33. Physician must obtain this number in order to practice within a state
Commerical Payer
State License Number
Dun/Dunning
Utilization review
34. Analysis of accounts receivable that indicate delinquency of 60 - 90 - 120 days
Aging Accounts
Group Provider Number
Assignment
Itemized Statement
35. Once claim is approved for payment Remittance Advice(RA) is sent to the provider and EOB is mailed to the policyholder
Basic Billing and Reimbursment Steps
Withhold Incentive
V.I. Payment
Adjustment
36. Bundling edits by CMS to combine various component items with a major service or procedure
Life Cycle of Insurance Claims
Civil Monetary Penalities Law (CMPL)
Adjustment
Correct Coding Initiative (CCI)
37. Early and Periodic Screenings - Diagnosis - and Treatment
FECA
Commerical Payer
EPSDT
Employer Indentification Number (EIN)
38. Amount representing the charge most frequently used by a physician in a given periord of time
Suspended File Report
V.I. Payment
Customary Charge
Basic Billing and Reimbursment Steps
39. Durable Medical Equipment Regional Carrier
Inquiry
Performing Provider Identification Number(PPIN)
DMERC
V.I. Payment
40. 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'
Medical Necessity
Unit Count
Suspended File Report
Electronic Claim
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
Basic Billing and Reimbursment Steps
Global Procedures
Encounter Form(Superbill)
Review
42. Amount of time allowed by an insurance company for a claim to be submitted for a payment from the date of service
Skip
Exclusions and Limatations
Group Provider Number
Timely Filing Clause
43. Established proce set by a medical practice for proefessional services
Truth in Lending
Fee Schedule
Peer Review Orginization (PRO)
Aging Accounts
44. Bundling edits by CMS to combine various component items with a major service or procedure
Conversion Factor
Peer Review Orginization (PRO)
Correct Coding Initiative (CCI)
Fee Schedule
45. Checking or tracing a claim sent to an insurance comapany to determine payment or processing status
Non-Covered Benefits
Inquiry
Fee-for-Service
Group Provider Number
46. 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
Clearinghouse
Skip
State License Number
Group Practice
47. 1. Blocks 1-13=patient info 2.Blocks 14-33=physicians info
Appeal
Exclusions and Limatations
Global Procedures
Claim Form is divided into 2 sections
48. Listing of claims that have incorrect information such as posting error or missing information to process a claim
Provider Identification Number (PIN)
FECA
Suspended File Report
Bundling
49. Listing of claims that have incorrect information such as posting error or missing information to process a claim
Truth in Lending
Explaination of Benefits
Encounter Form(Superbill)
Suspended File Report
50. Procedure or services provided without proper authorizationor was not covered by a current authorization -denied - provider can't bill patient for charges
Conversion Factor
Remittance Advice(RA)
Unarthorized Benefit
Commerical Payer