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. Early and Periodic Screenings - Diagnosis - and Treatment






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






3. 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






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






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






6. Federal Employees' Compensation Act






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






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






9. Amount charged by a practice when providing services






10. Using ICD-9 codes to hughest degree






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






12. 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`






13. 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






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






15. Federal Employees' Compensation Act






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






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






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






19. Assigned to the physician by Medicare program






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






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






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






23. Physician must obtain this number in order to practice within a state






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






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






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






27. Physician must obtain this number in order to practice within a state






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






29. 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






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






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






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






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






34. 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






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






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






37. 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






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






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






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






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






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






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






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






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






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






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






48. 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






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






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