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






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






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






4. 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'






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






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






7. Take what insurance pays






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






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






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






11. Amount charged by a practice when providing services






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






13. 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






14. Electronic or paper-based report of payment sent by the payer to the provider






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






16. Durable Medical Equipment Regional Carrier






17. 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






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






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






20. Federal Employees' Compensation Act






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






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






23. Early and Periodic Screenings - Diagnosis - and Treatment






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






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






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






27. Reimbursement directly sent from payer to provider






28. Process of converting diagnoses - procedures - and services into numeric and alpha-numeric characters






29. 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






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






31. 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






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






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






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






35. Superbill or Encounter Form






36. 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'






37. Using ICD-9 codes to hughest degree






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






39. 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






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






41. 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`






42. Early and Periodic Screenings - Diagnosis - and Treatment






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






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






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






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






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






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






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






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