SUBJECTS
|
BROWSE
|
CAREER CENTER
|
POPULAR
|
JOIN
|
LOGIN
Business Skills
|
Soft Skills
|
Basic Literacy
|
Certifications
About
|
Help
|
Privacy
|
Terms
|
Email
Search
Test your basic knowledge |
Medical Billing Claims Basics
Start Test
Study First
Subject
:
medical-transcription
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. Agreement between the patoent and the physician regarding monthly installments to pay a bill
Adjustment Codes
V.I. Payment
Truth in Lending
Global Period
2. Assigned to the physician by Medicare program
TWIP
Commerical Payer
Remittance Advice(RA)
Unique Provider Identification Number(UPIN)
3. Early and Periodic Screenings - Diagnosis - and Treatment
Peer Review Orginization (PRO)
Qualified Diagnosis
EPSDT
Health Care Clearinghouse
4. Authorization by a policyholder to allow a thrid-party payer to pay benefits to a health care provider
Assignment
Universal Claim Form
Profile
Aging Accounts
5. Federal Tax identification number - issued by internal revenue service -social security number used if employer doesn't have a EIN
Profile
Exclusions and Limatations
Timely Filing Clause
Employer Indentification Number (EIN)
6. Amount charged by a practice when providing services
Adjustment
Health Care Clearinghouse
Universal Claim Form
Actual Charge
7. Discount or fee exception given to a patient at the discretion of the physician
Component Billing
Appeal
Professional Courtesy
Truth in Lending
8. Checking or tracing a claim sent to an insurance comapany to determine payment or processing status
Peer Review Orginization (PRO)
Qualified Diagnosis
Inquiry
Qualified Diagnosis
9. Authorization by a policyholder to allow a thrid-party payer to pay benefits to a health care provider
Assignment
Ledger Card
Cycle Billing
Commerical Payer
10. Company that translates electroinc transactions between the standard formats and code set required under HIPAA and nonstandard formats and code sets
Adjustment
Health Care Clearinghouse
Truth in Lending
Specificty
11. Percent of payment held back for a risk account in the HMO program
Aging Report
Withhold Incentive
Unique Provider Identification Number(UPIN)
Adjudicate
12. Federal Employees' Compensation Act
FECA
V.I. Payment
Ranking Code
Insurance Adjustment(write off)
13. Company that translates electroinc transactions between the standard formats and code set required under HIPAA and nonstandard formats and code sets
Adjudicate
Fee-for-Service
Health Care Clearinghouse
Civil Monetary Penalities Law (CMPL)
14. A report to track claim status of patient accounts and to identify individual accounts requiring additional workup for payments or write-offs
Global Procedures
Aging Report
Universal Claim Form
Ledger Card
15. CMS 1500 - became effective July 2007 -All third party payers accept it - Medicare requires all physicians to use it
Paper Claims
Performing Provider Identification Number(PPIN)
Universal Claim Form
Coding
16. 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'
Medical Necessity
Collection Ratio
Life Cycle of Insurance Claims
Encounter Form(Superbill)
17. Request sent to an insurance comapany or other payer asking that a submitted claim be reconsidered for payment or processing
Appeal
EPSDT
Aging Accounts
Non-Covered Benefits
18. Describes the service billed and includes a breakdown of how payment is determined
The Patient Care Partnership(Patients Bill of Rights)
Global Procedures
Paper Claims
Explaination of Benefits
19. Bundling edits by CMS to combine various component items with a major service or procedure
Correct Coding Initiative (CCI)
Inquiry
Fee Schedule
Accepted Assignments
20. Private health insurance company or employer-based group insurance plan that pays claims for eligible participants
Paper Claims
Review
Performing Provider Identification Number(PPIN)
Commerical Payer
21. Statement of a patient's account history - showing DOS - detailed chrages - payments - day insurance claims was submitted - applicable adjusments - and account balances
Batching
Fiscal Intermediary (FI)
Cycle Billing
Itemized Statement
22. Physician has a seperate PPIN for each group/clinic in which they practices
Profile
FECA
Adjustment Codes
Performing Provider Identification Number(PPIN)
23. Request or message to remind a patient that the account is over due or delinquent
Unique Provider Identification Number(UPIN)
Itemized Statement
Group Practice
Dun/Dunning
24. Listing of claims that have incorrect information such as posting error or missing information to process a claim
Commerical Payer
Bundling
Suspended File Report
Dun/Dunning
25. Relationship between the amount of money owed and the amount of money collected
Open Account
Qualified Diagnosis
Health Care Clearinghouse
Collection Ratio
26. Electronic or paper-based report of payment sent by the payer to the provider
Insurance Adjustment(write off)
Remittance Advice(RA)
Specificty
Fiscal Intermediary (FI)
27. 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
Medical Necessity Edit Checks
Unique Provider Identification Number(UPIN)
Collection Ratio
Coordination of Benefits (COB)
28. Take what insurance pays
TWIP
Electronic Claim
Posting
Assignment of Benefits
29. Amount of time allowed by an insurance company for a claim to be submitted for a payment from the date of service
Timely Filing Clause
Global Procedures
Universal Claim Form
Basic Billing and Reimbursment Steps
30. Amount required by an insurance company that must be taken off a patient's acoount based on actual agreements and participation
Ledger Card
Actual Charge
Insurance Adjustment(write off)
Collection Ratio
31. Promote interest and well being of the patients and residents of healthcare facility
Unit Count
TWIP
The Patient Care Partnership(Patients Bill of Rights)
State License Number
32. Term for processing payment
Non-Covered Benefits
Adjudicate
DMERC
Remittance Advice(RA)
33. Process of looking over a cliam to assess payment amounts
Review
Insurance Adjustment(write off)
Encounter Form(Superbill)
Ledger Card
34. Listing of claims that have incorrect information such as posting error or missing information to process a claim
Life Cycle of Insurance Claims
Suspended File Report
Claim Form is divided into 2 sections
Basic Billing and Reimbursment Steps
35. Billing for each item service provided to a patient in accourdance with insurance carriers' policies
Encounter Form(Superbill)
Bundling
Commerical Payer
Component Billing
36. Once claim is approved for payment Remittance Advice(RA) is sent to the provider and EOB is mailed to the policyholder
Group Practice
Performing Provider Identification Number(PPIN)
Universal Claim Form
V.I. Payment
37. Once claim is approved for payment Remittance Advice(RA) is sent to the provider and EOB is mailed to the policyholder
Civil Monetary Penalities Law (CMPL)
V.I. Payment
Suspended File Report
Review
38. Means to report the number of times a service was provided on the same date of service to the same patient
Insurance Adjustment(write off)
Electronic Claim
Unit Count
Aging Accounts
39. 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`
Fiscal Intermediary (FI)
Insurance Adjustment(write off)
Inquiry
Paper Claims
40. 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
Adjustment
TWIP
Posting
Life Cycle of Insurance Claims
41. Insurance company that bids for a contract with CMS to handle the Medicare program in a specific area
Batching
Peer Review Orginization (PRO)
Customary Charge
Fiscal Intermediary (FI)
42. Request sent to an insurance comapany or other payer asking that a submitted claim be reconsidered for payment or processing
Actual Charge
Appeal
Customary Charge
The Patient Care Partnership(Patients Bill of Rights)
43. Reimbursement directly sent from payer to provider
Exclusions and Limatations
Professional Courtesy
Assignment of Benefits
Batching
44. Established proce set by a medical practice for proefessional services
Posting
Fee Schedule
Review
Conversion Factor
45. 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
Life Cycle of Insurance Claims
Encounter Form(Superbill)
Global Procedures
TWIP
46. Federal Tax identification number - issued by internal revenue service -social security number used if employer doesn't have a EIN
Employer Indentification Number (EIN)
Global Period
Clearinghouse
Insurance Adjustment(write off)
47. Electronic or paper-based report of payment sent by the payer to the provider
Remittance Advice(RA)
Aging Report
State License Number
Exclusions and Limatations
48. Using ICD-9 codes to hughest degree
Group Provider Number
Ledger Card
Correct Coding Initiative (CCI)
Specificty
49. Process of converting diagnoses - procedures - and services into numeric and alpha-numeric characters
Customary Charge
Utilization review
Inquiry
Coding
50. List of CPT codes used by a physician with a corresponding fee that is usually calculated and maintained by a third-party payer
Assignment of Benefits
Aging Report
Group Provider Number
Profile