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. 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






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






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






4. 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






5. Assigned to the physician by Medicare program






6. 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






7. 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






8. Take what insurance pays






9. 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'






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






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






12. Reimbursement directly sent from payer to provider






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






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






15. 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






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






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






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






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






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






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






22. 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






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






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






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






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






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






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






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






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






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






32. Durable Medical Equipment Regional Carrier






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






34. 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






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






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






37. 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






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






39. 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






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






41. Using ICD-9 codes to hughest degree






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






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






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






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






46. 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






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






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






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






50. Reimbursement directly sent from payer to provider