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Test your basic knowledge |
Medical Billing Claims Basics
Start Test
Study First
Subject
:
medical-transcription
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 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
Skip
DMERC
Adjustment
Group Provider Number
2. Discount or fee exception given to a patient at the discretion of the physician
Professional Courtesy
Performing Provider Identification Number(PPIN)
Peer Review Orginization (PRO)
Global Period
3. 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`
Professional Courtesy
Paper Claims
Encounter Form(Superbill)
Ledger Card
4. Agreement between the patoent and the physician regarding monthly installments to pay a bill
Unit Count
Adjudicate
Life Cycle of Insurance Claims
Truth in Lending
5. Company that translates electroinc transactions between the standard formats and code set required under HIPAA and nonstandard formats and code sets
Coding
Health Care Clearinghouse
The Patient Care Partnership(Patients Bill of Rights)
Commerical Payer
6. Percent of payment held back for a risk account in the HMO program
Accepted Assignments
Utilization review
Withhold Incentive
Fee Slip
7. Assigned to the physician by Medicare program
Global Period
Employer Indentification Number (EIN)
Unique Provider Identification Number(UPIN)
EPSDT
8. Bundling edits by CMS to combine various component items with a major service or procedure
Correct Coding Initiative (CCI)
Electronic Claim
Cycle Billing
Skip
9. Amount representing the charge most frequently used by a physician in a given periord of time
Actual Charge
Customary Charge
Coordination of Benefits (COB)
Exclusions and Limatations
10. Take what insurance pays
Unarthorized Benefit
TWIP
Itemized Statement
Conversion Factor
11. Insurance company that bids for a contract with CMS to handle the Medicare program in a specific area
Adjustment
Profile
Fiscal Intermediary (FI)
The Patient Care Partnership(Patients Bill of Rights)
12. Early and Periodic Screenings - Diagnosis - and Treatment
Unit Count
Review
EPSDT
DMERC
13. Accounts that are subject to charges from time to time
Appeal
Health Care Clearinghouse
Open Account
Profile
14. Request sent to an insurance comapany or other payer asking that a submitted claim be reconsidered for payment or processing
Coordination of Benefits (COB)
Inquiry
Appeal
Unarthorized Benefit
15. Working diagnosis which is not yet est.
Open Account
Collection Ratio
Qualified Diagnosis
Utilization review
16. Codes used by insurance compaines to explain actions taken on a Remittance Notice
The Patient Care Partnership(Patients Bill of Rights)
Adjustment Codes
Assignment
Non-Covered Benefits
17. Request or message to remind a patient that the account is over due or delinquent
EPSDT
Provider Identification Number (PIN)
Dun/Dunning
Unarthorized Benefit
18. 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
Peer Review Orginization (PRO)
EPSDT
Ledger Card
Group Practice
19. 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
Basic Billing and Reimbursment Steps
Skip
Employer Indentification Number (EIN)
Fee Schedule
20. Early and Periodic Screenings - Diagnosis - and Treatment
Batching
Bundling
Profile
EPSDT
21. Breaking the account receivable amounts into portions for billing at a specific date of the month
Skip
Claim Form is divided into 2 sections
Cycle Billing
Adjustment Codes
22. When two companies work together to decided payment of benefits
Electronic Claim
Remittance Advice(RA)
Coordination of Benefits (COB)
Exclusions and Limatations
23. Using ICD-9 codes to hughest degree
Specificty
V.I. Payment
Accepted Assignments
The Patient Care Partnership(Patients Bill of Rights)
24. Agreement between the patoent and the physician regarding monthly installments to pay a bill
Remittance Advice(RA)
Truth in Lending
State License Number
Unique Provider Identification Number(UPIN)
25. 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
Unit Count
DMERC
V.I. Payment
Group Provider Number
26. CMS 1500 - became effective July 2007 -All third party payers accept it - Medicare requires all physicians to use it
Universal Claim Form
Provider Identification Number (PIN)
Profile
Professional Courtesy
27. Combing lesser services with a major service in order for one charge to include that variety of service
Bundling
Timely Filing Clause
Qualified Diagnosis
Employer Indentification Number (EIN)
28. Electronic or paper-based report of payment sent by the payer to the provider
Employer Indentification Number (EIN)
Inquiry
Unarthorized Benefit
Remittance Advice(RA)
29. Number assigned by insurance companies to a physician who renders service to patients
Collection Ratio
Unarthorized Benefit
Provider Identification Number (PIN)
Qualified Diagnosis
30. When two companies work together to decided payment of benefits
Fee Slip
Coordination of Benefits (COB)
Qualified Diagnosis
Explaination of Benefits
31. 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
Group Practice
Conversion Factor
Itemized Statement
DMERC
32. Amount charged by a practice when providing services
Suspended File Report
Global Period
Actual Charge
Aging Accounts
33. Analysis of accounts receivable that indicate delinquency of 60 - 90 - 120 days
Aging Accounts
Medical Necessity
TWIP
Paper Claims
34. Established proce set by a medical practice for proefessional services
Fee Schedule
Collection Ratio
EPSDT
Ranking Code
35. 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
Life Cycle of Insurance Claims
The Patient Care Partnership(Patients Bill of Rights)
Medical Necessity Edit Checks
Unarthorized Benefit
36. Statement of a patient's account history - showing DOS - detailed chrages - payments - day insurance claims was submitted - applicable adjusments - and account balances
TWIP
Batching
Itemized Statement
Claim Form is divided into 2 sections
37. Means to report the number of times a service was provided on the same date of service to the same patient
Unit Count
Basic Billing and Reimbursment Steps
Peer Review Orginization (PRO)
Appeal
38. Term for processing payment
Explaination of Benefits
Adjudicate
Health Care Clearinghouse
EPSDT
39. Process of converting diagnoses - procedures - and services into numeric and alpha-numeric characters
Timely Filing Clause
Civil Monetary Penalities Law (CMPL)
Coding
Aging Accounts
40. Money amount determined by dividing the actual charge of a service or procedure by a relative unit
Conversion Factor
Fee-for-Service
Global Procedures
Life Cycle of Insurance Claims
41. 1. Blocks 1-13=patient info 2.Blocks 14-33=physicians info
EPSDT
Claim Form is divided into 2 sections
Fiscal Intermediary (FI)
Assignment of Benefits
42. Private health insurance company or employer-based group insurance plan that pays claims for eligible participants
FECA
Medical Necessity Edit Checks
Commerical Payer
Global Procedures
43. Checking or tracing a claim sent to an insurance comapany to determine payment or processing status
Professional Courtesy
Batching
Itemized Statement
Inquiry
44. Number assigned by insurance companies to a physician who renders service to patients
Encounter Form(Superbill)
Qualified Diagnosis
Specificty
Provider Identification Number (PIN)
45. Authorization by a policyholder to allow a thrid-party payer to pay benefits to a health care provider
DMERC
Unarthorized Benefit
Conversion Factor
Assignment
46. Analysis of accounts receivable that indicate delinquency of 60 - 90 - 120 days
Specificty
Component Billing
Aging Accounts
Suspended File Report
47. Discount or fee exception given to a patient at the discretion of the physician
Performing Provider Identification Number(PPIN)
Actual Charge
Professional Courtesy
Posting
48. Bundling edits by CMS to combine various component items with a major service or procedure
Correct Coding Initiative (CCI)
Medical Necessity
Fiscal Intermediary (FI)
Paper Claims
49. Specific time frames assigned to a code by an insurance comapny before additional payment will be made following a surgical procedure
Health Care Clearinghouse
Unit Count
DMERC
Global Period
50. Process or tansferring account information from a journal to a ledger
Review
Correct Coding Initiative (CCI)
Profile
Posting