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






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






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






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






5. 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






6. Assigned to the physician by Medicare program






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






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






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






10. 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






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






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






13. 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






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






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






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






17. Amount charged by a practice when providing services






18. Durable Medical Equipment Regional Carrier






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






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






21. Superbill or Encounter Form






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






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






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






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






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






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






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






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






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






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






33. Federal Employees' Compensation Act






34. 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






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






36. Using ICD-9 codes to hughest degree






37. 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`






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






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






40. 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






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






42. Amount charged by a practice when providing services






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






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






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






46. Reimbursement directly sent from payer to provider






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






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






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






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