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






2. Durable Medical Equipment Regional Carrier






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






4. Early and Periodic Screenings - Diagnosis - and Treatment






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'






6. Federal Employees' Compensation Act






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






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






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






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






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






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






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






14. Working diagnosis which is not yet est.






15. Take what insurance pays






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






17. 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






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






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






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






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






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






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






24. Federal Employees' Compensation Act






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






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






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






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






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






30. 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






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






32. 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






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






34. 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






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






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






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






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






40. Listing of diagnosis - procedures - and charges for a patients visit






41. Deferred or delayed processing method for inputting data a retrieval at a later date






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






43. 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






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






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






46. 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






47. Working diagnosis which is not yet est.






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






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






50. Take what insurance pays