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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. State based group of physicians working under government guideline to review cases and determine their appropriateness and quality of professional care
Fiscal Intermediary (FI)
Remittance Advice(RA)
Adjudicate
Peer Review Orginization (PRO)
2. Accounts that are subject to charges from time to time
Open Account
Appeal
Adjudicate
Fee-for-Service
3. Federal Tax identification number - issued by internal revenue service -social security number used if employer doesn't have a EIN
Specificty
Employer Indentification Number (EIN)
Coding
Group Practice
4. 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'
Medical Necessity
Skip
Group Provider Number
Withhold Incentive
5. Money amount determined by dividing the actual charge of a service or procedure by a relative unit
Fee Slip
Explaination of Benefits
Conversion Factor
Civil Monetary Penalities Law (CMPL)
6. Codes used by insurance compaines to explain actions taken on a Remittance Notice
Customary Charge
Adjudicate
Adjustment Codes
Unit Count
7. Take what insurance pays
TWIP
DMERC
Paper Claims
The Patient Care Partnership(Patients Bill of Rights)
8. Billing for each item service provided to a patient in accourdance with insurance carriers' policies
Truth in Lending
Assignment
Exclusions and Limatations
Component Billing
9. Agreement between the patoent and the physician regarding monthly installments to pay a bill
Truth in Lending
Fee Schedule
Global Procedures
Explaination of Benefits
10. Physician has a seperate PPIN for each group/clinic in which they practices
Performing Provider Identification Number(PPIN)
Actual Charge
Commerical Payer
Peer Review Orginization (PRO)
11. Amount charged by a practice when providing services
Actual Charge
Provider Identification Number (PIN)
Assignment of Benefits
Coding
12. Listing of claims that have incorrect information such as posting error or missing information to process a claim
Allowed Charge
Global Period
Suspended File Report
Ranking Code
13. 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
Performing Provider Identification Number(PPIN)
Fee-for-Service
Fee Slip
Coordination of Benefits (COB)
14. Electronic or paper-based report of payment sent by the payer to the provider
Remittance Advice(RA)
Unique Provider Identification Number(UPIN)
Clearinghouse
Exclusions and Limatations
15. Statement of a patient's account history - showing DOS - detailed chrages - payments - day insurance claims was submitted - applicable adjusments - and account balances
Exclusions and Limatations
Itemized Statement
Global Procedures
Ranking Code
16. Durable Medical Equipment Regional Carrier
Open Account
DMERC
Assignment
Actual Charge
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
Clearinghouse
Adjudicate
Assignment
Ledger Card
18. Number assigned by insurance companies to a physician who renders service to patients
Medical Necessity Edit Checks
Provider Identification Number (PIN)
Itemized Statement
Collection Ratio
19. Federal Tax identification number - issued by internal revenue service -social security number used if employer doesn't have a EIN
Employer Indentification Number (EIN)
Fee Schedule
Clearinghouse
Coordination of Benefits (COB)
20. Federal Employees' Compensation Act
Basic Billing and Reimbursment Steps
Qualified Diagnosis
FECA
Accepted Assignments
21. Major surgical procedures that typically have a follow-up period of 30 - 60 - 90 - 120 days
Customary Charge
Global Procedures
Actual Charge
Electronic Claim
22. Billing for each item service provided to a patient in accourdance with insurance carriers' policies
Component Billing
Encounter Form(Superbill)
Specificty
Medical Necessity
23. Early and Periodic Screenings - Diagnosis - and Treatment
Group Provider Number
Ledger Card
EPSDT
Insurance Adjustment(write off)
24. Agreement between the patoent and the physician regarding monthly installments to pay a bill
Truth in Lending
Commerical Payer
Civil Monetary Penalities Law (CMPL)
Batching
25. Listing service in their order of importance by dates of service and values. Highest charge to lowest charge
Qualified Diagnosis
Ranking Code
Provider Identification Number (PIN)
Conversion Factor
26. Once claim is approved for payment Remittance Advice(RA) is sent to the provider and EOB is mailed to the policyholder
Dun/Dunning
Encounter Form(Superbill)
Adjustment
V.I. Payment
27. Reimbursement directly sent from payer to provider
Global Period
Assignment of Benefits
Life Cycle of Insurance Claims
Civil Monetary Penalities Law (CMPL)
28. Process of converting diagnoses - procedures - and services into numeric and alpha-numeric characters
Coding
Truth in Lending
Unit Count
Timely Filing Clause
29. 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
Group Practice
FECA
Explaination of Benefits
Fee Slip
30. Passed by the federal government to prosecute cases of Medicaid fraud
Health Care Clearinghouse
Civil Monetary Penalities Law (CMPL)
The Patient Care Partnership(Patients Bill of Rights)
Accepted Assignments
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
Posting
Employer Indentification Number (EIN)
Utilization review
Adjustment
32. Conditions - situations - and services not covered by the insurance carrier
Peer Review Orginization (PRO)
Exclusions and Limatations
Posting
Universal Claim Form
33. Promote interest and well being of the patients and residents of healthcare facility
Life Cycle of Insurance Claims
Fee Slip
Exclusions and Limatations
The Patient Care Partnership(Patients Bill of Rights)
34. Insurance company that bids for a contract with CMS to handle the Medicare program in a specific area
Fiscal Intermediary (FI)
Electronic Claim
Accepted Assignments
Appeal
35. Superbill or Encounter Form
Component Billing
Medical Necessity
Fee Slip
Coordination of Benefits (COB)
36. 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'
Medical Necessity
Itemized Statement
Fee-for-Service
Performing Provider Identification Number(PPIN)
37. Using ICD-9 codes to hughest degree
Specificty
Truth in Lending
Assignment of Benefits
Component Billing
38. Analysis of accounts receivable that indicate delinquency of 60 - 90 - 120 days
Inquiry
Adjustment Codes
Aging Accounts
Non-Covered Benefits
39. 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
Accepted Assignments
Life Cycle of Insurance Claims
Timely Filing Clause
FECA
40. Combing lesser services with a major service in order for one charge to include that variety of service
Adjustment
EPSDT
Bundling
Truth in Lending
41. 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`
Encounter Form(Superbill)
Batching
Unit Count
Paper Claims
42. Early and Periodic Screenings - Diagnosis - and Treatment
Fiscal Intermediary (FI)
Suspended File Report
Coordination of Benefits (COB)
EPSDT
43. Procedure or services provided without proper authorizationor was not covered by a current authorization -denied - provider can't bill patient for charges
Unarthorized Benefit
Ranking Code
Conversion Factor
Life Cycle of Insurance Claims
44. 1. Blocks 1-13=patient info 2.Blocks 14-33=physicians info
Medical Necessity
DMERC
Medical Necessity Edit Checks
Claim Form is divided into 2 sections
45. When two companies work together to decided payment of benefits
Coordination of Benefits (COB)
Unique Provider Identification Number(UPIN)
Group Practice
Fiscal Intermediary (FI)
46. Private health insurance company or employer-based group insurance plan that pays claims for eligible participants
Adjudicate
The Patient Care Partnership(Patients Bill of Rights)
Commerical Payer
Provider Identification Number (PIN)
47. Specific time frames assigned to a code by an insurance comapny before additional payment will be made following a surgical procedure
Global Period
TWIP
Ranking Code
Fee-for-Service
48. Analysis of accounts receivable that indicate delinquency of 60 - 90 - 120 days
Accepted Assignments
Unit Count
Aging Accounts
Professional Courtesy
49. Passed by the federal government to prosecute cases of Medicaid fraud
Civil Monetary Penalities Law (CMPL)
EPSDT
Fee-for-Service
Collection Ratio
50. When two companies work together to decided payment of benefits
Life Cycle of Insurance Claims
EPSDT
Coordination of Benefits (COB)
Unarthorized Benefit