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






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






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






4. Federal Employees' Compensation Act






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






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






7. Superbill or Encounter Form






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






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






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






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






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






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






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






15. 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






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






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






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






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






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






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






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






23. Major surgical procedures that typically have a follow-up period of 30 - 60 - 90 - 120 days






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






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






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






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






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






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






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






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






32. 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






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






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






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






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






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






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






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






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






41. Billing for each item service provided to a patient in accourdance with insurance carriers' policies






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






43. 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






44. Durable Medical Equipment Regional Carrier






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






46. 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'






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






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






49. Durable Medical Equipment Regional Carrier






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