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. 1. Blocks 1-13=patient info 2.Blocks 14-33=physicians info






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






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






4. 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






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






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






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






8. 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






9. 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






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






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






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






13. 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






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






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






16. 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






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






18. Federal Employees' Compensation Act






19. Working diagnosis which is not yet est.






20. Reimbursement directly sent from payer to provider






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






22. Early and Periodic Screenings - Diagnosis - and Treatment






23. 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`






24. 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






25. Amount charged by a practice when providing services






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






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






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






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






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






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






32. Take what insurance pays






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






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






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






36. Superbill or Encounter Form






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






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






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






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






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






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






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






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






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






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






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






48. 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






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






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