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






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






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






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






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






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






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






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






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






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






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






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






13. Early and Periodic Screenings - Diagnosis - and Treatment






14. Reimbursement directly sent from payer to provider






15. Amount representing the charge most frequently used by a physician in a given periord of time






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






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






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






19. Assigned to the physician by Medicare program






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






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






22. Amount charged by a practice when providing services






23. Federal Employees' Compensation Act






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






25. 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






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






27. 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`






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






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






30. Federal Employees' Compensation Act






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






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






33. Assigned to the physician by Medicare program






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






35. Durable Medical Equipment Regional Carrier






36. 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






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






38. Take what insurance pays






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






40. Listing of diagnosis - procedures - and charges for a patients visit






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






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






43. 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






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






45. Term for processing payment






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






47. 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






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






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






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