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






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






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. 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






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






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






7. Amount representing the charge most frequently used by a physician in a given periord of time






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






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






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






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






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






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






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






15. Assigned to the physician by Medicare program






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






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






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






19. Number is used instead of the individuals physician's number for the performing provider who is a member of a group practice that sybmits claims to insurance complanies under the group name






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






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






22. Superbill or Encounter Form






23. Superbill or Encounter Form






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






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






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






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






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






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






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






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






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






33. Reimbursement directly sent from payer to provider






34. Using ICD-9 codes to hughest degree






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






36. Using ICD-9 codes to hughest degree






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






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






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






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






41. Amount representing the charge most frequently used by a physician in a given periord of time






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






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






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






45. Federal Employees' Compensation Act






46. 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`






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






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






49. 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






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






Can you answer 50 questions in 15 minutes?



Let me suggest you:

Browse all subjects

Browse all tests

Most popular tests



Major Subjects

Tests & Exams


AP
CLEP
DSST
GRE
SAT
GMAT

Browse all subjects

Browse all tests

Most popular tests