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






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






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






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






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






7. 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






8. 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






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






10. 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`






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






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






13. Discount or fee exception given to a patient at the discretion of the physician






14. Using ICD-9 codes to hughest degree






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






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






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






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






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






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






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






22. Federal Employees' Compensation Act






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






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






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






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






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






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






29. Amount charged by a practice when providing services






30. Take what insurance pays






31. Using ICD-9 codes to hughest degree






32. Federal Employees' Compensation Act






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






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






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






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






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






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






39. 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






40. 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






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






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






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






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






45. Amount charged by a practice when providing services






46. Durable Medical Equipment Regional Carrier






47. 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`






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






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






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