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






2. Working diagnosis which is not yet est.






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






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






5. 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






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






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






8. Federal Employees' Compensation Act






9. Reimbursement directly sent from payer to provider






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






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






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






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






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






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






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






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






18. 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'






19. Reimbursement directly sent from payer to provider






20. Accounts that are subject to charges from time to time






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






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






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






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






25. Amount charged by a practice when providing services






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






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






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






29. Take what insurance pays






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






31. 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






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






33. Accounts that are subject to charges from time to time






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






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






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






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






38. Term for processing payment






39. 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






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






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






42. 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






43. Term for processing payment






44. Durable Medical Equipment Regional Carrier






45. Superbill or Encounter Form






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






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






48. 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






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






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