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






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






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






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






5. Reimbursement directly sent from payer to provider






6. Working diagnosis which is not yet est.






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






8. 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






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






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






11. Term for processing payment






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






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






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






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






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






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






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






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






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






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






22. 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`






23. 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






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






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






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






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






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






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






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






31. Durable Medical Equipment Regional Carrier






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






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






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






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






36. Early and Periodic Screenings - Diagnosis - and Treatment






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






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






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






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






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






42. 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`






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






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






45. 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






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






48. 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






49. Federal Employees' Compensation Act






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