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






2. Means to report the number of times a service was provided on the same date of service to the same patient






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






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






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






6. The amount set by the carrier for the reimbursement of services






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






8. Superbill or Encounter Form






9. Using ICD-9 codes to hughest degree






10. Process of looking over a cliam to assess payment amounts






11. 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






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






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






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






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






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






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






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






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






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






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






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






23. 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






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






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






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






27. 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






28. 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`






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






30. The amount set by the carrier for the reimbursement of services






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






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






33. 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'






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






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






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






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






38. 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






39. 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






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






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






42. Reimbursement directly sent from payer to provider






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






44. Take what insurance pays






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






46. 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






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






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






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






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