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. Relationship between the amount of money owed and the amount of money collected






2. 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






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






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






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






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






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






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






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






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






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






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






13. 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






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






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






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






17. Means to report the number of times a service was provided on the same date of service to the same patient






18. Using ICD-9 codes to hughest degree






19. 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






20. Assigned to the physician by Medicare program






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






22. Federal Employees' Compensation Act






23. Conditions - situations - and services not covered by the insurance carrier






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






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






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






27. 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






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






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






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






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






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






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






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






35. Amount charged by a practice when providing services






36. Established proce set by a medical practice for proefessional services






37. Take what insurance pays






38. 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`






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






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






41. Breaking the account receivable amounts into portions for billing at a specific date of the month






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






43. Reimbursement directly sent from payer to provider






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






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






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






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






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






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






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