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






2. Using ICD-9 codes to hughest degree






3. Reimbursement directly sent from payer to provider






4. 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






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






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






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






8. Early and Periodic Screenings - Diagnosis - and Treatment






9. 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






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






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






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






13. Take what insurance pays






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






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






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






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






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






19. 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






20. Means to report the number of times a service was provided on the same date of service to the same patient






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






22. 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






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






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






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






26. 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'






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






28. Electronic or paper-based report of payment sent by the payer to the provider






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






30. 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






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






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






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






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






35. Term for processing payment






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






37. 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






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






39. 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






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






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






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






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






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






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






46. 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






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






48. Amount charged by a practice when providing services






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






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