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






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






3. 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






4. Process or tansferring account information from a journal to a ledger






5. 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






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






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






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






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






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






11. 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'






12. 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






13. Take what insurance pays






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






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






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






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






18. Working diagnosis which is not yet est.






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






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






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






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






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






24. 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






25. 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






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






27. Reimbursement directly sent from payer to provider






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






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






30. 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`






31. 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






32. Federal Employees' Compensation Act






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






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






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






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






37. Amount charged by a practice when providing services






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






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






40. Early and Periodic Screenings - Diagnosis - and Treatment






41. Working diagnosis which is not yet est.






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






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






44. 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`






45. 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






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






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






48. Superbill or Encounter Form






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






50. Durable Medical Equipment Regional Carrier