Test your basic knowledge |

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. 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






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






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






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






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






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






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






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






9. Take what insurance pays






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






11. Federal Employees' Compensation Act






12. Early and Periodic Screenings - Diagnosis - and Treatment






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






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






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






16. Term for processing payment






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






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






19. 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






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






21. 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






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






23. Amount charged by a practice when providing services






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






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






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






27. Number assigned by insurance companies to a physician who renders service to patients






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






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






30. Federal Employees' Compensation Act






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






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






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






34. 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






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






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






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






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






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






40. 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`






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






42. Superbill or Encounter Form






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






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






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






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






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






48. 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






49. Take what insurance pays






50. Discount or fee exception given to a patient at the discretion of the physician