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






2. 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`






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






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






6. Durable Medical Equipment Regional Carrier






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






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






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






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






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






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






13. Amount charged by a practice when providing services






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






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






16. 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






17. Assigned to the physician by Medicare program






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






19. 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






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






21. Once claim is approved for payment Remittance Advice(RA) is sent to the provider and EOB is mailed to the policyholder






22. Assigned to the physician by Medicare program






23. 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






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






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






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






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






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






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






30. 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`






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






32. 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






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






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






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






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






37. 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






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






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






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






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






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






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






44. Using ICD-9 codes to hughest degree






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






46. 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






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






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






49. Early and Periodic Screenings - Diagnosis - and Treatment






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