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






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






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






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






5. 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






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






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






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






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






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






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






12. 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






13. Superbill or Encounter Form






14. Amount charged by a practice when providing services






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






16. Reimbursement directly sent from payer to provider






17. Durable Medical Equipment Regional Carrier






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






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






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






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






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






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






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






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






26. Superbill or Encounter Form






27. 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`






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






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






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






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






32. Using ICD-9 codes to hughest degree






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






34. Early and Periodic Screenings - Diagnosis - and Treatment






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






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






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






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






39. 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






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






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






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






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






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






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






46. Working diagnosis which is not yet est.






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






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






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






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