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






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






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






4. 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`






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






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






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






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






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






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






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






12. Reimbursement directly sent from payer to provider






13. Using ICD-9 codes to hughest degree






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






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






16. 1.Claims submission-transmission of claims data either electronically or manually to third party payers or clearinghouse for processing 2.Claims processing- thrid party payers and clearinghouse verify the information found and submitted claims about






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






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






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






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






21. Superbill or Encounter Form






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






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






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






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






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






27. 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






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






29. 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






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






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






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






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






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






36. Process of assesing medical services to assure medical necessity and the appropriateness of treatment






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






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






39. Using ICD-9 codes to hughest degree






40. Alternative to paper claims submitted to the third-party payer directly by the physician or through clearinghouse -paid faster and software has self-editing detects and reports entries may cause to be rejected






41. 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






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






43. Superbill or Encounter Form






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






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






46. Take what insurance pays






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






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






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






50. Early and Periodic Screenings - Diagnosis - and Treatment