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






3. 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






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






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






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






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






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






9. Working diagnosis which is not yet est.






10. Assigned to the physician by Medicare program






11. Superbill or Encounter Form






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






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






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






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






16. Reimbursement directly sent from payer to provider






17. Insurance company that bids for a contract with CMS to handle the Medicare program in a specific area






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






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






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






21. Term for processing payment






22. 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`






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






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






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






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






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






28. Amount charged by a practice when providing services






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






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






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






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






33. 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`






34. 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






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






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






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






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






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






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






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






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






44. 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






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






46. Assigned to the physician by Medicare program






47. 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






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






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






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