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. Amount charged by a practice when providing services






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






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






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






5. 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






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






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






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






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






10. 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'






11. Durable Medical Equipment Regional Carrier






12. 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






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






14. Using ICD-9 codes to hughest degree






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






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






17. Entity that recieves transmissions of claims from physicians offices - seperates claims by carriers and performs software edits to check errors -once completed claim is sent to proper insurance -physician pays fee for their services






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






19. 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






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






21. 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






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






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






24. Take what insurance pays






25. 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






26. Specific time frames assigned to a code by an insurance comapny before additional payment will be made following a surgical procedure






27. Superbill or Encounter Form






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






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






30. Accounts that are subject to charges from time to time






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






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






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






34. Reimbursement directly sent from payer to provider






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






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






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






38. Assigned to the physician by Medicare program






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






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






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






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






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






44. Federal Employees' Compensation Act






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






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






47. Amount charged by a practice when providing services






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






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






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