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






2. 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






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






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






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






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. Reimbursement directly sent from payer to provider






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






10. 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






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






12. 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






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






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






15. Take what insurance pays






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






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






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






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






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






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






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






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






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






25. 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






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






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






28. 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






29. Term for processing payment






30. 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






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






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






33. Term for processing payment






34. 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'






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






36. 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






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






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






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






40. 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`






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






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






43. Amount charged by a practice when providing services






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






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






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






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






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






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






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