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Test your basic knowledge |
Medical Billing Claims Basics
Start Test
Study First
Subject
:
medical-transcription
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. Breaking the account receivable amounts into portions for billing at a specific date of the month
Group Provider Number
Remittance Advice(RA)
Cycle Billing
DMERC
2. Insurance company that bids for a contract with CMS to handle the Medicare program in a specific area
Dun/Dunning
Fiscal Intermediary (FI)
Allowed Charge
Basic Billing and Reimbursment Steps
3. Patient who owes a balance on the account who has moved without a forwarding address
Skip
Global Period
FECA
Clearinghouse
4. Breaking the account receivable amounts into portions for billing at a specific date of the month
Group Practice
Cycle Billing
The Patient Care Partnership(Patients Bill of Rights)
Life Cycle of Insurance Claims
5. Specific time frames assigned to a code by an insurance comapny before additional payment will be made following a surgical procedure
Global Period
Performing Provider Identification Number(PPIN)
Itemized Statement
Adjustment
6. Percent of payment held back for a risk account in the HMO program
Itemized Statement
Clearinghouse
Accepted Assignments
Withhold Incentive
7. Amount charged by a practice when providing services
Global Procedures
Actual Charge
Profile
Cycle Billing
8. Early and Periodic Screenings - Diagnosis - and Treatment
Adjudicate
EPSDT
Timely Filing Clause
Review
9. Take what insurance pays
Withhold Incentive
Paper Claims
TWIP
Actual Charge
10. Codes used by insurance compaines to explain actions taken on a Remittance Notice
EPSDT
Universal Claim Form
Professional Courtesy
Adjustment Codes
11. A report to track claim status of patient accounts and to identify individual accounts requiring additional workup for payments or write-offs
Batching
Review
Aging Report
Peer Review Orginization (PRO)
12. Listing service in their order of importance by dates of service and values. Highest charge to lowest charge
Inquiry
Ranking Code
Cycle Billing
Remittance Advice(RA)
13. 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
Explaination of Benefits
Utilization review
Unarthorized Benefit
Adjustment
14. Authorization by a policyholder to allow a thrid-party payer to pay benefits to a health care provider
Provider Identification Number (PIN)
Assignment
The Patient Care Partnership(Patients Bill of Rights)
Component Billing
15. Listing service in their order of importance by dates of service and values. Highest charge to lowest charge
Bundling
Withhold Incentive
Commerical Payer
Ranking Code
16. Process of looking over a cliam to assess payment amounts
FECA
Ranking Code
Review
Timely Filing Clause
17. The amount set by the carrier for the reimbursement of services
Basic Billing and Reimbursment Steps
Customary Charge
EPSDT
Allowed Charge
18. Deferred or delayed processing method for inputting data a retrieval at a later date
Allowed Charge
Batching
Skip
Performing Provider Identification Number(PPIN)
19. Process or tansferring account information from a journal to a ledger
Ledger Card
Paper Claims
Posting
Skip
20. Process of assesing medical services to assure medical necessity and the appropriateness of treatment
Utilization review
Cycle Billing
Life Cycle of Insurance Claims
Fee Slip
21. The amount set by the carrier for the reimbursement of services
Allowed Charge
Utilization review
Fee Slip
Coding
22. Amount required by an insurance company that must be taken off a patient's acoount based on actual agreements and participation
Correct Coding Initiative (CCI)
Allowed Charge
Insurance Adjustment(write off)
Fee-for-Service
23. 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
Global Period
Fee-for-Service
Ranking Code
Basic Billing and Reimbursment Steps
24. Analysis of accounts receivable that indicate delinquency of 60 - 90 - 120 days
Review
Aging Accounts
State License Number
Adjudicate
25. 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`
Open Account
Fiscal Intermediary (FI)
Paper Claims
Profile
26. List of CPT codes used by a physician with a corresponding fee that is usually calculated and maintained by a third-party payer
Profile
Unit Count
Fee Schedule
Coordination of Benefits (COB)
27. Money amount determined by dividing the actual charge of a service or procedure by a relative unit
Adjudicate
Skip
Conversion Factor
Bundling
28. 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
Unit Count
Paper Claims
Actual Charge
Non-Covered Benefits
29. Private health insurance company or employer-based group insurance plan that pays claims for eligible participants
Unique Provider Identification Number(UPIN)
Assignment of Benefits
Commerical Payer
Group Practice
30. Private health insurance company or employer-based group insurance plan that pays claims for eligible participants
Provider Identification Number (PIN)
Aging Accounts
Commerical Payer
Fiscal Intermediary (FI)
31. Take what insurance pays
Cycle Billing
Itemized Statement
Specificty
TWIP
32. Major surgical procedures that typically have a follow-up period of 30 - 60 - 90 - 120 days
EPSDT
V.I. Payment
Global Procedures
Group Provider Number
33. Once claim is approved for payment Remittance Advice(RA) is sent to the provider and EOB is mailed to the policyholder
V.I. Payment
Encounter Form(Superbill)
Dun/Dunning
Allowed Charge
34. State based group of physicians working under government guideline to review cases and determine their appropriateness and quality of professional care
Coordination of Benefits (COB)
Peer Review Orginization (PRO)
Insurance Adjustment(write off)
Dun/Dunning
35. Once claim is approved for payment Remittance Advice(RA) is sent to the provider and EOB is mailed to the policyholder
Coordination of Benefits (COB)
Clearinghouse
Health Care Clearinghouse
V.I. Payment
36. Promote interest and well being of the patients and residents of healthcare facility
V.I. Payment
Coding
Review
The Patient Care Partnership(Patients Bill of Rights)
37. Procedure or services provided without proper authorizationor was not covered by a current authorization -denied - provider can't bill patient for charges
Coordination of Benefits (COB)
Electronic Claim
Unarthorized Benefit
Actual Charge
38. Electronic or paper-based report of payment sent by the payer to the provider
Universal Claim Form
Remittance Advice(RA)
Qualified Diagnosis
Commerical Payer
39. Relationship between the amount of money owed and the amount of money collected
Utilization review
Collection Ratio
Adjustment
State License Number
40. Insurance company that bids for a contract with CMS to handle the Medicare program in a specific area
Dun/Dunning
Fiscal Intermediary (FI)
Global Procedures
Utilization review
41. 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
Basic Billing and Reimbursment Steps
Explaination of Benefits
Ledger Card
Fee-for-Service
42. 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
Medical Necessity Edit Checks
Group Provider Number
Itemized Statement
Allowed Charge
43. Company that translates electroinc transactions between the standard formats and code set required under HIPAA and nonstandard formats and code sets
Health Care Clearinghouse
Skip
TWIP
Peer Review Orginization (PRO)
44. Statement of a patient's account history - showing DOS - detailed chrages - payments - day insurance claims was submitted - applicable adjusments - and account balances
Itemized Statement
Global Procedures
Medical Necessity
Clearinghouse
45. Physician has a seperate PPIN for each group/clinic in which they practices
Health Care Clearinghouse
Review
Aging Accounts
Performing Provider Identification Number(PPIN)
46. Discount or fee exception given to a patient at the discretion of the physician
Unarthorized Benefit
Bundling
Professional Courtesy
Unit Count
47. 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
Adjustment
Aging Report
Peer Review Orginization (PRO)
Health Care Clearinghouse
48. Amount charged by a practice when providing services
Open Account
Non-Covered Benefits
Actual Charge
Medical Necessity Edit Checks
49. Number assigned by insurance companies to a physician who renders service to patients
Provider Identification Number (PIN)
Suspended File Report
Clearinghouse
Review
50. Passed by the federal government to prosecute cases of Medicaid fraud
Ledger Card
Allowed Charge
Civil Monetary Penalities Law (CMPL)
Itemized Statement