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. 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






3. Fee that is charged for each procedure pr service performed by the physician -fee is obtained from a fee schedule - list of charges or allowance that have accepted for specific medical services






4. 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






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






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






7. 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






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






9. Working diagnosis which is not yet est.






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






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






12. Early and Periodic Screenings - Diagnosis - and Treatment






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






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






15. Take what insurance pays






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






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






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






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






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






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






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






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






24. 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






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






26. Using ICD-9 codes to hughest degree






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






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






29. 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






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






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






32. Procedure or services provided without proper authorizationor was not covered by a current authorization -denied - provider can't bill patient for charges






33. Promote interest and well being of the patients and residents of healthcare facility






34. Reimbursement directly sent from payer to provider






35. Superbill or Encounter Form






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






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






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






39. 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






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






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






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






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






44. Assigned to the physician by Medicare program






45. Amount of time allowed by an insurance company for a claim to be submitted for a payment from the date of service






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






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






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






49. 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






50. List of CPT codes used by a physician with a corresponding fee that is usually calculated and maintained by a third-party payer