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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. Listing of claims that have incorrect information such as posting error or missing information to process a claim
Suspended File Report
Global Period
Insurance Adjustment(write off)
DMERC
2. Provider agrees to accept what insurance company approves as payment in full for the claim
Universal Claim Form
State License Number
Fee Slip
Accepted Assignments
3. Amount charged by a practice when providing services
Aging Report
Actual Charge
Aging Accounts
Profile
4. Insurance company that bids for a contract with CMS to handle the Medicare program in a specific area
Adjudicate
Fiscal Intermediary (FI)
Health Care Clearinghouse
Coding
5. 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'
Correct Coding Initiative (CCI)
DMERC
Medical Necessity
Encounter Form(Superbill)
6. Means to report the number of times a service was provided on the same date of service to the same patient
Group Practice
Global Period
Unit Count
Conversion Factor
7. Accounts that are subject to charges from time to time
Correct Coding Initiative (CCI)
Coordination of Benefits (COB)
Global Procedures
Open Account
8. Private health insurance company or employer-based group insurance plan that pays claims for eligible participants
State License Number
Commerical Payer
Profile
Remittance Advice(RA)
9. Bundling edits by CMS to combine various component items with a major service or procedure
Medical Necessity
Peer Review Orginization (PRO)
Truth in Lending
Correct Coding Initiative (CCI)
10. 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
Non-Covered Benefits
Correct Coding Initiative (CCI)
Performing Provider Identification Number(PPIN)
Posting
11. Take what insurance pays
Encounter Form(Superbill)
Customary Charge
TWIP
Batching
12. Reimbursement directly sent from payer to provider
Non-Covered Benefits
State License Number
Qualified Diagnosis
Assignment of Benefits
13. Money amount determined by dividing the actual charge of a service or procedure by a relative unit
Universal Claim Form
Health Care Clearinghouse
Actual Charge
Conversion Factor
14. 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'
Cycle Billing
Collection Ratio
Medical Necessity
Basic Billing and Reimbursment Steps
15. 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
Life Cycle of Insurance Claims
Explaination of Benefits
Suspended File Report
Actual Charge
16. Checking or tracing a claim sent to an insurance comapany to determine payment or processing status
Inquiry
Assignment of Benefits
Unit Count
Claim Form is divided into 2 sections
17. Request or message to remind a patient that the account is over due or delinquent
Component Billing
Inquiry
Dun/Dunning
Posting
18. 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
Assignment
Group Practice
Clearinghouse
Health Care Clearinghouse
19. Early and Periodic Screenings - Diagnosis - and Treatment
Qualified Diagnosis
DMERC
EPSDT
The Patient Care Partnership(Patients Bill of Rights)
20. Process of assesing medical services to assure medical necessity and the appropriateness of treatment
Accepted Assignments
V.I. Payment
Utilization review
Open Account
21. Combing lesser services with a major service in order for one charge to include that variety of service
Bundling
Dun/Dunning
Global Procedures
Open Account
22. Billing for each item service provided to a patient in accourdance with insurance carriers' policies
Global Period
Non-Covered Benefits
Component Billing
Claim Form is divided into 2 sections
23. 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`
Health Care Clearinghouse
Paper Claims
Assignment
Civil Monetary Penalities Law (CMPL)
24. 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
Medical Necessity Edit Checks
Customary Charge
Actual Charge
Provider Identification Number (PIN)
25. 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
Life Cycle of Insurance Claims
Clearinghouse
Remittance Advice(RA)
Skip
26. Provider agrees to accept what insurance company approves as payment in full for the claim
Global Period
Exclusions and Limatations
Allowed Charge
Accepted Assignments
27. Request or message to remind a patient that the account is over due or delinquent
Utilization review
Dun/Dunning
Fee Schedule
Medical Necessity Edit Checks
28. Insurance company that bids for a contract with CMS to handle the Medicare program in a specific area
EPSDT
Fiscal Intermediary (FI)
Health Care Clearinghouse
Explaination of Benefits
29. Company that translates electroinc transactions between the standard formats and code set required under HIPAA and nonstandard formats and code sets
Unit Count
Health Care Clearinghouse
State License Number
Provider Identification Number (PIN)
30. Take what insurance pays
Fiscal Intermediary (FI)
Cycle Billing
TWIP
Accepted Assignments
31. Agreement between the patoent and the physician regarding monthly installments to pay a bill
The Patient Care Partnership(Patients Bill of Rights)
Conversion Factor
Truth in Lending
Electronic Claim
32. Physician must obtain this number in order to practice within a state
State License Number
Explaination of Benefits
Ranking Code
TWIP
33. Using ICD-9 codes to hughest degree
Specificty
Ranking Code
Exclusions and Limatations
Timely Filing Clause
34. List of CPT codes used by a physician with a corresponding fee that is usually calculated and maintained by a third-party payer
Group Practice
Appeal
Profile
Ledger Card
35. Analysis of accounts receivable that indicate delinquency of 60 - 90 - 120 days
Review
Aging Report
Aging Accounts
TWIP
36. 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
Review
Customary Charge
Basic Billing and Reimbursment Steps
Clearinghouse
37. Amount charged by a practice when providing services
Actual Charge
Paper Claims
Unarthorized Benefit
Open Account
38. Request sent to an insurance comapany or other payer asking that a submitted claim be reconsidered for payment or processing
Bundling
Non-Covered Benefits
Appeal
Actual Charge
39. Federal Tax identification number - issued by internal revenue service -social security number used if employer doesn't have a EIN
Group Practice
Employer Indentification Number (EIN)
Group Provider Number
Unarthorized Benefit
40. Combing lesser services with a major service in order for one charge to include that variety of service
Fiscal Intermediary (FI)
Global Procedures
Dun/Dunning
Bundling
41. Amount representing the charge most frequently used by a physician in a given periord of time
Fiscal Intermediary (FI)
Batching
Customary Charge
Remittance Advice(RA)
42. Term for processing payment
Aging Report
Adjudicate
Utilization review
Inquiry
43. Assigned to the physician by Medicare program
Bundling
Unit Count
Appeal
Unique Provider Identification Number(UPIN)
44. 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
Cycle Billing
Global Period
Fiscal Intermediary (FI)
45. Bundling edits by CMS to combine various component items with a major service or procedure
Correct Coding Initiative (CCI)
Medical Necessity Edit Checks
Group Practice
Assignment
46. 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
Dun/Dunning
Group Practice
FECA
Performing Provider Identification Number(PPIN)
47. List of CPT codes used by a physician with a corresponding fee that is usually calculated and maintained by a third-party payer
Collection Ratio
Withhold Incentive
Profile
Batching
48. Durable Medical Equipment Regional Carrier
Correct Coding Initiative (CCI)
Unit Count
DMERC
FECA
49. 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
Commerical Payer
Group Provider Number
Appeal
Correct Coding Initiative (CCI)
50. Describes the service billed and includes a breakdown of how payment is determined
Insurance Adjustment(write off)
Medical Necessity Edit Checks
Explaination of Benefits
Unique Provider Identification Number(UPIN)