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. When two companies work together to decided payment of benefits






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






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






4. Federal Employees' Compensation Act






5. Checking or tracing a claim sent to an insurance comapany to determine payment or processing status






6. Using ICD-9 codes to hughest degree






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






8. 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






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






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






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






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






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






14. 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






15. Reimbursement directly sent from payer to provider






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






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






18. Reimbursement directly sent from payer to provider






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






20. 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






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






22. 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






23. Superbill or Encounter Form






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






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






26. Entity that recieves transmissions of claims from physicians offices - seperates claims by carriers and performs software edits to check errors -once completed claim is sent to proper insurance -physician pays fee for their services






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






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






29. Term for processing payment






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






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






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






33. 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'






34. Federal Employees' Compensation Act






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






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






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






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






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






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






41. Percent of payment held back for a risk account in the HMO program






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






43. Using ICD-9 codes to hughest degree






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






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






46. Breaking the account receivable amounts into portions for billing at a specific date of the month






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






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






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






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