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






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






3. 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`






4. Take what insurance pays






5. Using ICD-9 codes to hughest degree






6. 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






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






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






9. 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






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






11. Durable Medical Equipment Regional Carrier






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






13. Percent of payment held back for a risk account in the HMO program






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






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






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






17. Superbill or Encounter Form






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






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






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






21. 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






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






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






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






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






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






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






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






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






30. 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






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






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






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






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






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






36. Percent of payment held back for a risk account in the HMO program






37. Term for processing payment






38. Federal Employees' Compensation Act






39. Early and Periodic Screenings - Diagnosis - and Treatment






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






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






42. 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






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






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






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






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






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






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






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






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