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. Amount charged by a practice when providing services






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






3. 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






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






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






6. 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






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






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






9. The amount set by the carrier for the reimbursement of services






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






11. Using ICD-9 codes to hughest degree






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






13. Assigned to the physician by Medicare program






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






15. Federal Employees' Compensation Act






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






17. 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






18. Early and Periodic Screenings - Diagnosis - and Treatment






19. 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






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






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






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






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






24. 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






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






26. Superbill or Encounter Form






27. 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






28. 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






29. Promote interest and well being of the patients and residents of healthcare facility






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






31. The amount set by the carrier for the reimbursement of services






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






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






34. Promote interest and well being of the patients and residents of healthcare facility






35. Reimbursement directly sent from payer to provider






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






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






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






39. 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






40. Major surgical procedures that typically have a follow-up period of 30 - 60 - 90 - 120 days






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






42. Term for processing payment






43. Working diagnosis which is not yet est.






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






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






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






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






48. Assigned to the physician by Medicare program






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






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