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






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






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






4. Reimbursement directly sent from payer to provider






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






6. 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






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






8. 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






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






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






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






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






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






14. Using ICD-9 codes to hughest degree






15. Physician must obtain this number in order to practice within a state






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






17. 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'






18. Term for processing payment






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






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






21. 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






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






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






24. Passed by the federal government to prosecute cases of Medicaid fraud






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






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






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






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






29. Term for processing payment






30. 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'






31. Amount charged by a practice when providing services






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






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






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






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






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






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






38. Take what insurance pays






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






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






41. 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






42. 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






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






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






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






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






47. Early and Periodic Screenings - Diagnosis - and Treatment






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






49. 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






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







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