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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. Term for processing payment
Fee Schedule
Adjudicate
Provider Identification Number (PIN)
Batching
2. Procedure or services provided without proper authorizationor was not covered by a current authorization -denied - provider can't bill patient for charges
Unarthorized Benefit
Accepted Assignments
Exclusions and Limatations
Open Account
3. Assigned to the physician by Medicare program
Unique Provider Identification Number(UPIN)
Qualified Diagnosis
Ledger Card
Specificty
4. Once claim is approved for payment Remittance Advice(RA) is sent to the provider and EOB is mailed to the policyholder
Withhold Incentive
Bundling
Profile
V.I. Payment
5. Using ICD-9 codes to hughest degree
Customary Charge
Component Billing
Specificty
Dun/Dunning
6. Request sent to an insurance comapany or other payer asking that a submitted claim be reconsidered for payment or processing
Collection Ratio
Medical Necessity Edit Checks
Professional Courtesy
Appeal
7. Durable Medical Equipment Regional Carrier
Cycle Billing
TWIP
DMERC
Truth in Lending
8. Means to report the number of times a service was provided on the same date of service to the same patient
Unit Count
Assignment of Benefits
Encounter Form(Superbill)
Medical Necessity
9. Agreement between the patoent and the physician regarding monthly installments to pay a bill
Truth in Lending
Customary Charge
Clearinghouse
Electronic Claim
10. When two companies work together to decided payment of benefits
Collection Ratio
Suspended File Report
V.I. Payment
Coordination of Benefits (COB)
11. Established proce set by a medical practice for proefessional services
Life Cycle of Insurance Claims
Fee Schedule
Provider Identification Number (PIN)
Batching
12. CMS 1500 - became effective July 2007 -All third party payers accept it - Medicare requires all physicians to use it
Adjustment Codes
Universal Claim Form
Group Practice
Conversion Factor
13. Conditions - situations - and services not covered by the insurance carrier
Universal Claim Form
Exclusions and Limatations
Professional Courtesy
Conversion Factor
14. 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`
Clearinghouse
Utilization review
Paper Claims
Adjudicate
15. Federal Tax identification number - issued by internal revenue service -social security number used if employer doesn't have a EIN
Fee Schedule
Employer Indentification Number (EIN)
Qualified Diagnosis
Medical Necessity
16. Passed by the federal government to prosecute cases of Medicaid fraud
Profile
Civil Monetary Penalities Law (CMPL)
Customary Charge
Medical Necessity Edit Checks
17. Promote interest and well being of the patients and residents of healthcare facility
Inquiry
Actual Charge
The Patient Care Partnership(Patients Bill of Rights)
Allowed Charge
18. 1. Blocks 1-13=patient info 2.Blocks 14-33=physicians info
Employer Indentification Number (EIN)
Global Period
DMERC
Claim Form is divided into 2 sections
19. Amount required by an insurance company that must be taken off a patient's acoount based on actual agreements and participation
Profile
Insurance Adjustment(write off)
Truth in Lending
Global Procedures
20. 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
Profile
Fee Slip
Group Provider Number
Posting
21. Take what insurance pays
Clearinghouse
Assignment of Benefits
Non-Covered Benefits
TWIP
22. Request sent to an insurance comapany or other payer asking that a submitted claim be reconsidered for payment or processing
Appeal
Medical Necessity Edit Checks
Assignment of Benefits
EPSDT
23. Combing lesser services with a major service in order for one charge to include that variety of service
Fee Slip
Bundling
Assignment of Benefits
Inquiry
24. A report to track claim status of patient accounts and to identify individual accounts requiring additional workup for payments or write-offs
Aging Report
Customary Charge
Customary Charge
Commerical Payer
25. A report to track claim status of patient accounts and to identify individual accounts requiring additional workup for payments or write-offs
Aging Report
Coordination of Benefits (COB)
Adjudicate
EPSDT
26. 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'
Non-Covered Benefits
Medical Necessity
Peer Review Orginization (PRO)
Global Procedures
27. Analysis of accounts receivable that indicate delinquency of 60 - 90 - 120 days
Actual Charge
Provider Identification Number (PIN)
Aging Accounts
Coordination of Benefits (COB)
28. Process or tansferring account information from a journal to a ledger
Posting
Correct Coding Initiative (CCI)
Cycle Billing
Performing Provider Identification Number(PPIN)
29. 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
Allowed Charge
Appeal
Medical Necessity Edit Checks
Component Billing
30. 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
Accepted Assignments
Paper Claims
Group Provider Number
Group Practice
31. Describes the service billed and includes a breakdown of how payment is determined
Timely Filing Clause
Employer Indentification Number (EIN)
Open Account
Explaination of Benefits
32. Means to report the number of times a service was provided on the same date of service to the same patient
Explaination of Benefits
Unit Count
Review
Accepted Assignments
33. Analysis of accounts receivable that indicate delinquency of 60 - 90 - 120 days
Aging Accounts
State License Number
Cycle Billing
DMERC
34. Amount of time allowed by an insurance company for a claim to be submitted for a payment from the date of service
Global Procedures
Allowed Charge
The Patient Care Partnership(Patients Bill of Rights)
Timely Filing Clause
35. Federal Employees' Compensation Act
Allowed Charge
Fee Slip
FECA
Health Care Clearinghouse
36. Electronic or paper-based report of payment sent by the payer to the provider
Open Account
Remittance Advice(RA)
Explaination of Benefits
Itemized Statement
37. Checking or tracing a claim sent to an insurance comapany to determine payment or processing status
Civil Monetary Penalities Law (CMPL)
Electronic Claim
Inquiry
Actual Charge
38. Physician must obtain this number in order to practice within a state
Unit Count
Aging Report
Commerical Payer
State License Number
39. List of CPT codes used by a physician with a corresponding fee that is usually calculated and maintained by a third-party payer
Withhold Incentive
Skip
Profile
Batching
40. Procedure or services provided without proper authorizationor was not covered by a current authorization -denied - provider can't bill patient for charges
State License Number
FECA
Basic Billing and Reimbursment Steps
Unarthorized Benefit
41. Relationship between the amount of money owed and the amount of money collected
Collection Ratio
Performing Provider Identification Number(PPIN)
Fiscal Intermediary (FI)
Employer Indentification Number (EIN)
42. 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
Cycle Billing
Unit Count
Non-Covered Benefits
Performing Provider Identification Number(PPIN)
43. 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
Adjudicate
Review
Adjustment
Insurance Adjustment(write off)
44. Superbill or Encounter Form
Conversion Factor
Fee Slip
Unarthorized Benefit
Ranking Code
45. Describes the service billed and includes a breakdown of how payment is determined
Electronic Claim
Explaination of Benefits
Dun/Dunning
Unit Count
46. Early and Periodic Screenings - Diagnosis - and Treatment
Professional Courtesy
Assignment of Benefits
Itemized Statement
EPSDT
47. Process of converting diagnoses - procedures - and services into numeric and alpha-numeric characters
Exclusions and Limatations
Truth in Lending
Coding
Explaination of Benefits
48. Percent of payment held back for a risk account in the HMO program
Withhold Incentive
Assignment of Benefits
Batching
Fee-for-Service
49. Patient who owes a balance on the account who has moved without a forwarding address
DMERC
Skip
V.I. Payment
Aging Report
50. Listing service in their order of importance by dates of service and values. Highest charge to lowest charge
Claim Form is divided into 2 sections
Fee Slip
Ranking Code
Basic Billing and Reimbursment Steps