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






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






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






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






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






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






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






8. 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`






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






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






11. Describes the service billed and includes a breakdown of how payment is determined






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






13. 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






14. Federal Employees' Compensation Act






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






16. Physician must obtain this number in order to practice within a state






17. Term for processing payment






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






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






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






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






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






24. Working diagnosis which is not yet est.






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






26. Reimbursement directly sent from payer to provider






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






28. Durable Medical Equipment Regional Carrier






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






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






31. 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'






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






33. 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






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






35. Assigned to the physician by Medicare program






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






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






38. 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






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






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






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






42. 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'






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






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






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






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






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






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






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






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