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






2. 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'






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






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






5. 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






6. 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'






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






8. Working diagnosis which is not yet est.






9. 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`






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






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






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






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






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






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






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






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






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






19. 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






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






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






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






23. Established proce set by a medical practice for proefessional services






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






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






26. Amount charged by a practice when providing services






27. Take what insurance pays






28. Superbill or Encounter Form






29. Reimbursement directly sent from payer to provider






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






31. Assigned to the physician by Medicare program






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






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






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






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






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






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






38. 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






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






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






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






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






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






44. 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`






45. Term for processing payment






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






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






48. 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






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






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