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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. 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






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






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






4. 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






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






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






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






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






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






10. Using ICD-9 codes to hughest degree






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






12. Superbill or Encounter Form






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






14. 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`






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






16. Reimbursement directly sent from payer to provider






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






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






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






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






21. 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






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






23. Using ICD-9 codes to hughest degree






24. 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






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






26. Assigned to the physician by Medicare program






27. Amount charged by a practice when providing services






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






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






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






31. 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






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






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






34. Federal Employees' Compensation Act






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






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






37. 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






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






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






40. Take what insurance pays






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






42. 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






43. Take what insurance pays






44. Amount charged by a practice when providing services






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






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






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






48. Working diagnosis which is not yet est.






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






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







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