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






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






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






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






5. Process of converting diagnoses - procedures - and services into numeric and alpha-numeric characters






6. Reimbursement directly sent from payer to provider






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






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






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






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






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






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






13. 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






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






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






16. 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






17. 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






18. 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






19. 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






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






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






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






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






24. Analysis of accounts receivable that indicate delinquency of 60 - 90 - 120 days






25. 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






26. 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'






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






28. 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






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






30. Reimbursement directly sent from payer to provider






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






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






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






34. 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






35. 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






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






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






38. Using ICD-9 codes to hughest degree






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






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






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






42. 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






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






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






45. Working diagnosis which is not yet est.






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






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






48. Amount charged by a practice when providing services






49. Take what insurance pays






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