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






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






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






4. Amount charged by a practice when providing services






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






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






7. 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






8. Working diagnosis which is not yet est.






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






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






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






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






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






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






15. Assigned to the physician by Medicare program






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






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






18. 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`






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






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






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






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






23. Early and Periodic Screenings - Diagnosis - and Treatment






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






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






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






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






28. Reimbursement directly sent from payer to provider






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






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






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






32. 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






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






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






35. 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






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






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






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






39. 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`






40. 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






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






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






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






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






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






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






47. Using ICD-9 codes to hughest degree






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






49. 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






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