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. Durable Medical Equipment Regional Carrier






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






3. Assigned to the physician by Medicare program






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






5. 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






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






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






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






9. Durable Medical Equipment Regional Carrier






10. 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






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






12. 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






13. 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






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






15. 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






16. Reimbursement directly sent from payer to provider






17. Process of assesing medical services to assure medical necessity and the appropriateness of treatment






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






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






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






21. When two companies work together to decided payment of benefits






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






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






24. Process of assesing medical services to assure medical necessity and the appropriateness of treatment






25. 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






26. Process of converting diagnoses - procedures - and services into numeric and alpha-numeric characters






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






28. Superbill or Encounter Form






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






30. Process of converting diagnoses - procedures - and services into numeric and alpha-numeric characters






31. 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'






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






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






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






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






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






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






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






39. 1. Blocks 1-13=patient info 2.Blocks 14-33=physicians info






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






41. Working diagnosis which is not yet est.






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






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






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






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






46. Patient who owes a balance on the account who has moved without a forwarding address






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






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






49. 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






50. 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