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






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






3. Durable Medical Equipment Regional Carrier






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






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






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






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






8. Working diagnosis which is not yet est.






9. Means to report the number of times a service was provided on the same date of service to the same patient






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






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






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






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






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






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






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






17. 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






18. Bundling edits by CMS to combine various component items with a major service or procedure






19. Using ICD-9 codes to hughest degree






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






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






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






23. Take what insurance pays






24. 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






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






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






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






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






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






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






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






32. 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






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






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






35. Superbill or Encounter Form






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






37. 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






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






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`






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






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






42. Amount charged by a practice when providing services






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






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






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






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






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






48. CMS 1500 - became effective July 2007 -All third party payers accept it - Medicare requires all physicians to use it






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






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