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Test your basic knowledge |
Medical Billing Claims Basics
Start Test
Study First
Subject
:
medical-transcription
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. Statement of a patient's account history - showing DOS - detailed chrages - payments - day insurance claims was submitted - applicable adjusments - and account balances
FECA
Itemized Statement
Ranking Code
Commerical Payer
2. When two companies work together to decided payment of benefits
Unarthorized Benefit
Appeal
Coordination of Benefits (COB)
Clearinghouse
3. Amount charged by a practice when providing services
Actual Charge
Global Procedures
Qualified Diagnosis
Life Cycle of Insurance Claims
4. Term for processing payment
Adjudicate
Qualified Diagnosis
Universal Claim Form
Life Cycle of Insurance Claims
5. Take what insurance pays
TWIP
Claim Form is divided into 2 sections
Actual Charge
Explaination of Benefits
6. Major surgical procedures that typically have a follow-up period of 30 - 60 - 90 - 120 days
Fee-for-Service
Global Procedures
Provider Identification Number (PIN)
Ranking Code
7. 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
Itemized Statement
Adjudicate
Basic Billing and Reimbursment Steps
Collection Ratio
8. Take what insurance pays
TWIP
Performing Provider Identification Number(PPIN)
Global Procedures
Employer Indentification Number (EIN)
9. Amount required by an insurance company that must be taken off a patient's acoount based on actual agreements and participation
Coordination of Benefits (COB)
Paper Claims
Electronic Claim
Insurance Adjustment(write off)
10. Provider agrees to accept what insurance company approves as payment in full for the claim
Collection Ratio
Accepted Assignments
Commerical Payer
Fiscal Intermediary (FI)
11. Passed by the federal government to prosecute cases of Medicaid fraud
State License Number
Ranking Code
Coding
Civil Monetary Penalities Law (CMPL)
12. Promote interest and well being of the patients and residents of healthcare facility
Specificty
Remittance Advice(RA)
Fee-for-Service
The Patient Care Partnership(Patients Bill of Rights)
13. 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
Coding
Open Account
Non-Covered Benefits
Aging Accounts
14. Company that translates electroinc transactions between the standard formats and code set required under HIPAA and nonstandard formats and code sets
Itemized Statement
Bundling
FECA
Health Care Clearinghouse
15. 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
Posting
Open Account
Electronic Claim
Paper Claims
16. Process of looking over a cliam to assess payment amounts
Medical Necessity Edit Checks
Posting
FECA
Review
17. Private health insurance company or employer-based group insurance plan that pays claims for eligible participants
Skip
Commerical Payer
Open Account
V.I. Payment
18. Record to track patients charges - payments - adjustments - and balance due
Inquiry
Universal Claim Form
Ledger Card
Unique Provider Identification Number(UPIN)
19. Codes used by insurance compaines to explain actions taken on a Remittance Notice
Assignment of Benefits
Adjustment Codes
Life Cycle of Insurance Claims
Utilization review
20. Authorization by a policyholder to allow a thrid-party payer to pay benefits to a health care provider
Collection Ratio
EPSDT
Assignment
Ranking Code
21. Promote interest and well being of the patients and residents of healthcare facility
Posting
The Patient Care Partnership(Patients Bill of Rights)
Timely Filing Clause
Review
22. Listing of diagnosis - procedures - and charges for a patients visit
Encounter Form(Superbill)
Remittance Advice(RA)
FECA
Fee Schedule
23. Established proce set by a medical practice for proefessional services
Component Billing
Fee Schedule
Collection Ratio
Global Procedures
24. Request sent to an insurance comapany or other payer asking that a submitted claim be reconsidered for payment or processing
Ledger Card
The Patient Care Partnership(Patients Bill of Rights)
Appeal
Unique Provider Identification Number(UPIN)
25. Number assigned by insurance companies to a physician who renders service to patients
Bundling
Provider Identification Number (PIN)
State License Number
Batching
26. Amount representing the charge most frequently used by a physician in a given periord of time
Customary Charge
Ranking Code
Posting
Qualified Diagnosis
27. Federal Tax identification number - issued by internal revenue service -social security number used if employer doesn't have a EIN
Assignment
Peer Review Orginization (PRO)
Civil Monetary Penalities Law (CMPL)
Employer Indentification Number (EIN)
28. Process or tansferring account information from a journal to a ledger
Unit Count
DMERC
Posting
Aging Accounts
29. Describes the service billed and includes a breakdown of how payment is determined
Bundling
State License Number
Withhold Incentive
Explaination of Benefits
30. Specific time frames assigned to a code by an insurance comapny before additional payment will be made following a surgical procedure
State License Number
Conversion Factor
Global Period
Adjustment Codes
31. 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
Fee Slip
Group Practice
Ledger Card
Accepted Assignments
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
Life Cycle of Insurance Claims
Unit Count
Fee Schedule
Itemized Statement
33. Physician has a seperate PPIN for each group/clinic in which they practices
Aging Accounts
Allowed Charge
Component Billing
Performing Provider Identification Number(PPIN)
34. Conditions - situations - and services not covered by the insurance carrier
Group Practice
Coordination of Benefits (COB)
Adjustment Codes
Exclusions and Limatations
35. Passed by the federal government to prosecute cases of Medicaid fraud
Universal Claim Form
Civil Monetary Penalities Law (CMPL)
Batching
State License Number
36. Money amount determined by dividing the actual charge of a service or procedure by a relative unit
TWIP
Conversion Factor
Paper Claims
Performing Provider Identification Number(PPIN)
37. Established proce set by a medical practice for proefessional services
Fee Schedule
Correct Coding Initiative (CCI)
Skip
Clearinghouse
38. Agreement between the patoent and the physician regarding monthly installments to pay a bill
Truth in Lending
Collection Ratio
Ranking Code
Appeal
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`
Dun/Dunning
Insurance Adjustment(write off)
Paper Claims
Specificty
40. Assigned to the physician by Medicare program
Unique Provider Identification Number(UPIN)
Accepted Assignments
Provider Identification Number (PIN)
Medical Necessity Edit Checks
41. Process of converting diagnoses - procedures - and services into numeric and alpha-numeric characters
Employer Indentification Number (EIN)
Coding
Truth in Lending
Fiscal Intermediary (FI)
42. Durable Medical Equipment Regional Carrier
Unarthorized Benefit
DMERC
The Patient Care Partnership(Patients Bill of Rights)
Life Cycle of Insurance Claims
43. The amount set by the carrier for the reimbursement of services
Customary Charge
Electronic Claim
FECA
Allowed Charge
44. Authorization by a policyholder to allow a thrid-party payer to pay benefits to a health care provider
Universal Claim Form
V.I. Payment
Adjustment Codes
Assignment
45. Procedure or services provided without proper authorizationor was not covered by a current authorization -denied - provider can't bill patient for charges
Unarthorized Benefit
Bundling
Profile
TWIP
46. Breaking the account receivable amounts into portions for billing at a specific date of the month
Unarthorized Benefit
Life Cycle of Insurance Claims
Cycle Billing
Itemized Statement
47. Discount or fee exception given to a patient at the discretion of the physician
Life Cycle of Insurance Claims
EPSDT
DMERC
Professional Courtesy
48. Relationship between the amount of money owed and the amount of money collected
Adjudicate
Aging Accounts
Posting
Collection Ratio
49. Durable Medical Equipment Regional Carrier
Performing Provider Identification Number(PPIN)
Exclusions and Limatations
DMERC
Cycle Billing
50. Combing lesser services with a major service in order for one charge to include that variety of service
V.I. Payment
Employer Indentification Number (EIN)
Bundling
Adjustment Codes