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






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






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






4. 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`






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






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






7. 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






8. 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






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






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






11. Superbill or Encounter Form






12. Take what insurance pays






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






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






15. 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






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






17. Working diagnosis which is not yet est.






18. Early and Periodic Screenings - Diagnosis - and Treatment






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






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






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






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






23. 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






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






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






26. Assigned to the physician by Medicare program






27. 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






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






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






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






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






32. 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'






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






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






35. Reimbursement directly sent from payer to provider






36. 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






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






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






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






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






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






42. 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






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






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






45. 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






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






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






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






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






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