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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. Insurance company that bids for a contract with CMS to handle the Medicare program in a specific area






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






3. 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






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






5. Amount charged by a practice when providing services






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






7. 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






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






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






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






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






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






13. When two companies work together to decided payment of benefits






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






15. 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`






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






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






18. Using ICD-9 codes to hughest degree






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






20. Authorization by a policyholder to allow a thrid-party payer to pay benefits to a health care provider






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






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






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






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






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






26. Insurance company that bids for a contract with CMS to handle the Medicare program in a specific area






27. Federal Employees' Compensation Act






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






29. Early and Periodic Screenings - Diagnosis - and Treatment






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






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






32. Early and Periodic Screenings - Diagnosis - and Treatment






33. When two companies work together to decided payment of benefits






34. Amount charged by a practice when providing services






35. 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






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






37. Federal Employees' Compensation Act






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






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






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






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






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






43. Superbill or Encounter Form






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






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






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






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






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






49. 1. Blocks 1-13=patient info 2.Blocks 14-33=physicians info






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






Can you answer 50 questions in 15 minutes?



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