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






2. 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






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






4. 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






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






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






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






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






9. Durable Medical Equipment Regional Carrier






10. 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






11. Early and Periodic Screenings - Diagnosis - and Treatment






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






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






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






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






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






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






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






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






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






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






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






23. 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






24. Take what insurance pays






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






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






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






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






30. Federal Employees' Compensation Act






31. Assigned to the physician by Medicare program






32. 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'






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






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






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






36. 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






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






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






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






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






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






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






43. 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






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






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






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






47. 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






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






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






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