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






3. 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`






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






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






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






7. Assigned to the physician by Medicare program






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






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






10. Take what insurance pays






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






12. Early and Periodic Screenings - Diagnosis - and Treatment






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






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






15. Working diagnosis which is not yet est.






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






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






18. 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






19. 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






20. Early and Periodic Screenings - Diagnosis - and Treatment






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






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






23. Using ICD-9 codes to hughest degree






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






25. 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






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






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






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






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






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






31. 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






32. Amount charged by a practice when providing services






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






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






35. 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






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






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






38. Term for processing payment






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






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






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






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






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






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






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






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






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






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






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






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