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






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






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






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






5. Early and Periodic Screenings - Diagnosis - and Treatment






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






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






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






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






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






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






12. Federal Employees' Compensation Act






13. 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'






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






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






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






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






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






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






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






21. 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






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






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






24. Working diagnosis which is not yet est.






25. Durable Medical Equipment Regional Carrier






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






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






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






29. 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






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






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






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






33. Take what insurance pays






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






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






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






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






38. Relationship between the amount of money owed and the amount of money collected






39. Early and Periodic Screenings - Diagnosis - and Treatment






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






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






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






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






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






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






46. 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






47. Using ICD-9 codes to hughest degree






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






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






50. Using ICD-9 codes to hughest degree