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Test your basic knowledge |
Medical Billing Claims Basics
Start Test
Study First
Subject
:
medical-transcription
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. Request sent to an insurance comapany or other payer asking that a submitted claim be reconsidered for payment or processing
Fee Slip
Provider Identification Number (PIN)
Appeal
Withhold Incentive
2. Discount or fee exception given to a patient at the discretion of the physician
Medical Necessity
Claim Form is divided into 2 sections
Professional Courtesy
Explaination of Benefits
3. Billing for each item service provided to a patient in accourdance with insurance carriers' policies
Component Billing
Health Care Clearinghouse
Explaination of Benefits
Unit Count
4. Physician has a seperate PPIN for each group/clinic in which they practices
Global Period
Ranking Code
Fee Slip
Performing Provider Identification Number(PPIN)
5. CMS 1500 - became effective July 2007 -All third party payers accept it - Medicare requires all physicians to use it
Unique Provider Identification Number(UPIN)
Bundling
Adjudicate
Universal Claim Form
6. 1. Blocks 1-13=patient info 2.Blocks 14-33=physicians info
Medical Necessity Edit Checks
Coding
Claim Form is divided into 2 sections
Truth in Lending
7. Once claim is approved for payment Remittance Advice(RA) is sent to the provider and EOB is mailed to the policyholder
Inquiry
Itemized Statement
Profile
V.I. Payment
8. Process or tansferring account information from a journal to a ledger
Unit Count
Exclusions and Limatations
Posting
Unarthorized Benefit
9. Federal Tax identification number - issued by internal revenue service -social security number used if employer doesn't have a EIN
Employer Indentification Number (EIN)
Exclusions and Limatations
Component Billing
Adjustment Codes
10. Bundling edits by CMS to combine various component items with a major service or procedure
The Patient Care Partnership(Patients Bill of Rights)
State License Number
Correct Coding Initiative (CCI)
Accepted Assignments
11. 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
Life Cycle of Insurance Claims
Skip
Correct Coding Initiative (CCI)
DMERC
12. 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
Unique Provider Identification Number(UPIN)
Adjustment
Skip
Assignment
13. Superbill or Encounter Form
Fee Slip
Adjustment Codes
Universal Claim Form
Civil Monetary Penalities Law (CMPL)
14. Deferred or delayed processing method for inputting data a retrieval at a later date
Exclusions and Limatations
Dun/Dunning
Commerical Payer
Batching
15. Assigned to the physician by Medicare program
Component Billing
Customary Charge
Ranking Code
Unique Provider Identification Number(UPIN)
16. 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
Explaination of Benefits
Insurance Adjustment(write off)
Medical Necessity Edit Checks
Commerical Payer
17. Promote interest and well being of the patients and residents of healthcare facility
Paper Claims
Coordination of Benefits (COB)
The Patient Care Partnership(Patients Bill of Rights)
Fee Slip
18. A report to track claim status of patient accounts and to identify individual accounts requiring additional workup for payments or write-offs
Basic Billing and Reimbursment Steps
Medical Necessity Edit Checks
Aging Report
Open Account
19. Amount required by an insurance company that must be taken off a patient's acoount based on actual agreements and participation
Fee Slip
Insurance Adjustment(write off)
Accepted Assignments
Global Period
20. 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`
Paper Claims
Life Cycle of Insurance Claims
Inquiry
Unarthorized Benefit
21. Amount charged by a practice when providing services
Accepted Assignments
Actual Charge
Universal Claim Form
Itemized Statement
22. Insurance company that bids for a contract with CMS to handle the Medicare program in a specific area
Clearinghouse
Conversion Factor
Fiscal Intermediary (FI)
Adjustment Codes
23. 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
Group Practice
Itemized Statement
Coding
Posting
24. 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
Group Practice
Clearinghouse
Health Care Clearinghouse
Universal Claim Form
25. Relationship between the amount of money owed and the amount of money collected
Dun/Dunning
Suspended File Report
Collection Ratio
Fiscal Intermediary (FI)
26. Federal Employees' Compensation Act
Non-Covered Benefits
EPSDT
FECA
Provider Identification Number (PIN)
27. Conditions - situations - and services not covered by the insurance carrier
Insurance Adjustment(write off)
Exclusions and Limatations
Employer Indentification Number (EIN)
EPSDT
28. Specific time frames assigned to a code by an insurance comapny before additional payment will be made following a surgical procedure
Profile
FECA
Civil Monetary Penalities Law (CMPL)
Global Period
29. Private health insurance company or employer-based group insurance plan that pays claims for eligible participants
Commerical Payer
Inquiry
Assignment
Encounter Form(Superbill)
30. Money amount determined by dividing the actual charge of a service or procedure by a relative unit
Customary Charge
Conversion Factor
Fee Schedule
Aging Accounts
31. List of CPT codes used by a physician with a corresponding fee that is usually calculated and maintained by a third-party payer
Actual Charge
Peer Review Orginization (PRO)
Profile
Electronic Claim
32. A report to track claim status of patient accounts and to identify individual accounts requiring additional workup for payments or write-offs
Basic Billing and Reimbursment Steps
Aging Report
Group Practice
Encounter Form(Superbill)
33. Authorization by a policyholder to allow a thrid-party payer to pay benefits to a health care provider
Conversion Factor
Assignment of Benefits
Clearinghouse
Assignment
34. Codes used by insurance compaines to explain actions taken on a Remittance Notice
Adjustment Codes
Group Provider Number
The Patient Care Partnership(Patients Bill of Rights)
Fee Schedule
35. Process of looking over a cliam to assess payment amounts
Remittance Advice(RA)
Assignment
Review
Actual Charge
36. Passed by the federal government to prosecute cases of Medicaid fraud
Profile
Civil Monetary Penalities Law (CMPL)
Fee-for-Service
Professional Courtesy
37. 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
Assignment
Electronic Claim
Claim Form is divided into 2 sections
Timely Filing Clause
38. 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
Basic Billing and Reimbursment Steps
Group Provider Number
Posting
Ledger Card
39. Describes the service billed and includes a breakdown of how payment is determined
Explaination of Benefits
Itemized Statement
Adjustment Codes
Unarthorized Benefit
40. Breaking the account receivable amounts into portions for billing at a specific date of the month
Suspended File Report
Ranking Code
Fiscal Intermediary (FI)
Cycle Billing
41. 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
Explaination of Benefits
Universal Claim Form
Adjustment
Paper Claims
42. Listing service in their order of importance by dates of service and values. Highest charge to lowest charge
Claim Form is divided into 2 sections
Explaination of Benefits
Health Care Clearinghouse
Ranking Code
43. Major surgical procedures that typically have a follow-up period of 30 - 60 - 90 - 120 days
Claim Form is divided into 2 sections
EPSDT
Cycle Billing
Global Procedures
44. When two companies work together to decided payment of benefits
Fee Schedule
Profile
Coordination of Benefits (COB)
Civil Monetary Penalities Law (CMPL)
45. 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
Group Provider Number
Unique Provider Identification Number(UPIN)
Conversion Factor
FECA
46. Federal Tax identification number - issued by internal revenue service -social security number used if employer doesn't have a EIN
Group Provider Number
Ledger Card
Employer Indentification Number (EIN)
DMERC
47. Accounts that are subject to charges from time to time
Open Account
Performing Provider Identification Number(PPIN)
Utilization review
Claim Form is divided into 2 sections
48. Process of converting diagnoses - procedures - and services into numeric and alpha-numeric characters
V.I. Payment
Aging Accounts
Adjustment
Coding
49. Deferred or delayed processing method for inputting data a retrieval at a later date
Coding
Batching
Unarthorized Benefit
Global Period
50. Durable Medical Equipment Regional Carrier
Professional Courtesy
Paper Claims
Global Procedures
DMERC