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. 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






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






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






4. 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






5. Assigned to the physician by Medicare program






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






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






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






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






10. 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'






11. Take what insurance pays






12. 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






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






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






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






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






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






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






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






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






21. 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






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






23. Specific time frames assigned to a code by an insurance comapny before additional payment will be made following a surgical procedure






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






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






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






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






28. 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






29. 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'






30. 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






31. Reimbursement directly sent from payer to provider






32. Assigned to the physician by Medicare program






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






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






35. Working diagnosis which is not yet est.






36. Specific time frames assigned to a code by an insurance comapny before additional payment will be made following a surgical procedure






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






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






39. 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






40. 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






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






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






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






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






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






46. 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`






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






48. Federal Employees' Compensation Act






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






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