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. Working diagnosis which is not yet est.






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






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






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






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






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






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






8. Reimbursement directly sent from payer to provider






9. Assigned to the physician by Medicare program






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






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






12. 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






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






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






15. Term for processing payment






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






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






18. Take what insurance pays






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






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






21. Superbill or Encounter Form






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






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






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






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






26. Amount required by an insurance company that must be taken off a patient's acoount based on actual agreements and participation






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






28. Amount charged by a practice when providing services






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






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






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






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






33. 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






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






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






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






37. 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






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






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






40. 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






41. Using ICD-9 codes to hughest degree






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






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






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






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






46. 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






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






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






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






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