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. Term for processing payment






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






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






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






5. 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'






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






7. 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






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






9. 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






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






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






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






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






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






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






16. 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






17. Take what insurance pays






18. Early and Periodic Screenings - Diagnosis - and Treatment






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






20. Amount charged by a practice when providing services






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






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






23. Early and Periodic Screenings - Diagnosis - and Treatment






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






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






26. 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






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






28. Working diagnosis which is not yet est.






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






30. Durable Medical Equipment Regional Carrier






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






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






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






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






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






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






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






38. Federal Employees' Compensation Act






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






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






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






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






43. Procedure or services provided without proper authorizationor was not covered by a current authorization -denied - provider can't bill patient for charges






44. 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`






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






46. 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`






47. Superbill or Encounter Form






48. Assigned to the physician by Medicare program






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






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