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






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






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






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






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






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






7. Take what insurance pays






8. 1.Claims submission-transmission of claims data either electronically or manually to third party payers or clearinghouse for processing 2.Claims processing- thrid party payers and clearinghouse verify the information found and submitted claims about






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






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






11. 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






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






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






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






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






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






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






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






19. 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






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






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






22. Term for processing payment






23. 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






24. 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






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






26. Superbill or Encounter Form






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






28. Assigned to the physician by Medicare program






29. Process of looking over a cliam to assess payment amounts






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






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






32. Term for processing payment






33. 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






34. 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






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






36. Reimbursement directly sent from payer to provider






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






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






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






40. 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






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






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






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






44. 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`






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






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






47. Take what insurance pays






48. 1.Claims submission-transmission of claims data either electronically or manually to third party payers or clearinghouse for processing 2.Claims processing- thrid party payers and clearinghouse verify the information found and submitted claims about






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






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