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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. Procedure or services provided without proper authorizationor was not covered by a current authorization -denied - provider can't bill patient for charges
Profile
Cycle Billing
Global Period
Unarthorized Benefit
2. 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
Component Billing
Group Practice
Review
Adjustment Codes
3. 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
Medical Necessity Edit Checks
Adjustment Codes
Fiscal Intermediary (FI)
Accepted Assignments
4. Listing of claims that have incorrect information such as posting error or missing information to process a claim
Suspended File Report
Universal Claim Form
Withhold Incentive
Assignment
5. Request or message to remind a patient that the account is over due or delinquent
Provider Identification Number (PIN)
Ranking Code
Basic Billing and Reimbursment Steps
Dun/Dunning
6. 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
Unique Provider Identification Number(UPIN)
Open Account
Adjustment
Encounter Form(Superbill)
7. Once claim is approved for payment Remittance Advice(RA) is sent to the provider and EOB is mailed to the policyholder
Timely Filing Clause
V.I. Payment
Truth in Lending
Explaination of Benefits
8. Breaking the account receivable amounts into portions for billing at a specific date of the month
Itemized Statement
Unarthorized Benefit
Cycle Billing
Inquiry
9. CMS 1500 - became effective July 2007 -All third party payers accept it - Medicare requires all physicians to use it
Posting
Conversion Factor
Universal Claim Form
Specificty
10. Request sent to an insurance comapany or other payer asking that a submitted claim be reconsidered for payment or processing
The Patient Care Partnership(Patients Bill of Rights)
Open Account
Appeal
DMERC
11. Physician must obtain this number in order to practice within a state
Actual Charge
State License Number
Adjustment
Remittance Advice(RA)
12. Amount of time allowed by an insurance company for a claim to be submitted for a payment from the date of service
Component Billing
Timely Filing Clause
Unarthorized Benefit
TWIP
13. Electronic or paper-based report of payment sent by the payer to the provider
Remittance Advice(RA)
Qualified Diagnosis
Performing Provider Identification Number(PPIN)
Global Procedures
14. 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
Appeal
Assignment of Benefits
Clearinghouse
Electronic Claim
15. 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
Provider Identification Number (PIN)
Posting
Dun/Dunning
Basic Billing and Reimbursment Steps
16. 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
Fee-for-Service
Exclusions and Limatations
Truth in Lending
Universal Claim Form
17. Listing of diagnosis - procedures - and charges for a patients visit
Appeal
Dun/Dunning
Encounter Form(Superbill)
Performing Provider Identification Number(PPIN)
18. Company that translates electroinc transactions between the standard formats and code set required under HIPAA and nonstandard formats and code sets
Assignment of Benefits
Health Care Clearinghouse
Encounter Form(Superbill)
Inquiry
19. Money amount determined by dividing the actual charge of a service or procedure by a relative unit
Claim Form is divided into 2 sections
Conversion Factor
Health Care Clearinghouse
Global Period
20. Reimbursement directly sent from payer to provider
Peer Review Orginization (PRO)
Actual Charge
Assignment of Benefits
Qualified Diagnosis
21. Means to report the number of times a service was provided on the same date of service to the same patient
Truth in Lending
Unit Count
Fee Schedule
Bundling
22. Money amount determined by dividing the actual charge of a service or procedure by a relative unit
Universal Claim Form
Clearinghouse
Conversion Factor
Group Practice
23. 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`
Cycle Billing
Customary Charge
Global Procedures
Paper Claims
24. Term for processing payment
Paper Claims
Adjudicate
Accepted Assignments
Correct Coding Initiative (CCI)
25. Analysis of accounts receivable that indicate delinquency of 60 - 90 - 120 days
Aging Accounts
Correct Coding Initiative (CCI)
Assignment of Benefits
Bundling
26. When two companies work together to decided payment of benefits
Timely Filing Clause
Peer Review Orginization (PRO)
Coordination of Benefits (COB)
Adjustment Codes
27. Conditions - situations - and services not covered by the insurance carrier
Exclusions and Limatations
Non-Covered Benefits
Basic Billing and Reimbursment Steps
Cycle Billing
28. Accounts that are subject to charges from time to time
EPSDT
Universal Claim Form
Adjustment
Open Account
29. Checking or tracing a claim sent to an insurance comapany to determine payment or processing status
Actual Charge
Allowed Charge
Inquiry
Universal Claim Form
30. Established proce set by a medical practice for proefessional services
Medical Necessity Edit Checks
Specificty
Remittance Advice(RA)
Fee Schedule
31. Listing service in their order of importance by dates of service and values. Highest charge to lowest charge
Coding
Truth in Lending
Ranking Code
Medical Necessity
32. Reimbursement directly sent from payer to provider
Global Period
Assignment of Benefits
Group Practice
Fee-for-Service
33. 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
Group Provider Number
The Patient Care Partnership(Patients Bill of Rights)
Paper Claims
Electronic Claim
34. 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
Claim Form is divided into 2 sections
Accepted Assignments
Appeal
Basic Billing and Reimbursment Steps
35. Statement of a patient's account history - showing DOS - detailed chrages - payments - day insurance claims was submitted - applicable adjusments - and account balances
Itemized Statement
Correct Coding Initiative (CCI)
Provider Identification Number (PIN)
Accepted Assignments
36. Amount representing the charge most frequently used by a physician in a given periord of time
Civil Monetary Penalities Law (CMPL)
Unarthorized Benefit
Customary Charge
V.I. Payment
37. Amount representing the charge most frequently used by a physician in a given periord of time
Performing Provider Identification Number(PPIN)
Aging Accounts
Customary Charge
Electronic Claim
38. Using ICD-9 codes to hughest degree
Encounter Form(Superbill)
Specificty
Provider Identification Number (PIN)
Non-Covered Benefits
39. Deferred or delayed processing method for inputting data a retrieval at a later date
Batching
Withhold Incentive
Employer Indentification Number (EIN)
Exclusions and Limatations
40. List of CPT codes used by a physician with a corresponding fee that is usually calculated and maintained by a third-party payer
Aging Accounts
Basic Billing and Reimbursment Steps
Profile
Life Cycle of Insurance Claims
41. Accounts that are subject to charges from time to time
Employer Indentification Number (EIN)
Open Account
Fee-for-Service
EPSDT
42. 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
Adjudicate
Paper Claims
Group Practice
TWIP
43. Assigned to the physician by Medicare program
EPSDT
Ranking Code
Electronic Claim
Unique Provider Identification Number(UPIN)
44. State based group of physicians working under government guideline to review cases and determine their appropriateness and quality of professional care
Aging Accounts
Peer Review Orginization (PRO)
Clearinghouse
Unarthorized Benefit
45. Federal Tax identification number - issued by internal revenue service -social security number used if employer doesn't have a EIN
TWIP
Exclusions and Limatations
Unarthorized Benefit
Employer Indentification Number (EIN)
46. Patient who owes a balance on the account who has moved without a forwarding address
Skip
Withhold Incentive
Civil Monetary Penalities Law (CMPL)
Appeal
47. Early and Periodic Screenings - Diagnosis - and Treatment
Fee-for-Service
Qualified Diagnosis
EPSDT
Timely Filing Clause
48. Physician must obtain this number in order to practice within a state
Unique Provider Identification Number(UPIN)
State License Number
EPSDT
Performing Provider Identification Number(PPIN)
49. 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
Qualified Diagnosis
Adjustment Codes
Clearinghouse
Professional Courtesy
50. Defined by Medicare as 'The determination that a service or procedure rendered is resonable and necessary for the diagnosis or treatment of an illness or injury'
Allowed Charge
Adjustment Codes
Paper Claims
Medical Necessity