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. 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






2. 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






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






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






5. 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






6. Request or message to remind a patient that the account is over due or delinquent






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






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






9. Superbill or Encounter Form






10. Insurance company that bids for a contract with CMS to handle the Medicare program in a specific area






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






12. Reimbursement directly sent from payer to provider






13. Reimbursement directly sent from payer to provider






14. 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






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






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






17. Listing of claims that have incorrect information such as posting error or missing information to process a claim






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






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






20. Using ICD-9 codes to hughest degree






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






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






23. Listing of claims that have incorrect information such as posting error or missing information to process a claim






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






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






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






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






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






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






30. 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






31. 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'






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






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






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






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






36. 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'






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






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






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






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






41. Working diagnosis which is not yet est.






42. Term for processing payment






43. 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






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






45. 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`






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






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






48. Amount charged by a practice when providing services






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






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