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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. The amount set by the carrier for the reimbursement of services
Dun/Dunning
Allowed Charge
Explaination of Benefits
Group Provider Number
2. Bundling edits by CMS to combine various component items with a major service or procedure
Correct Coding Initiative (CCI)
Posting
Open Account
Basic Billing and Reimbursment Steps
3. Billing for each item service provided to a patient in accourdance with insurance carriers' policies
Batching
Component Billing
Insurance Adjustment(write off)
The Patient Care Partnership(Patients Bill of Rights)
4. Listing of diagnosis - procedures - and charges for a patients visit
Commerical Payer
Accepted Assignments
Aging Accounts
Encounter Form(Superbill)
5. 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
Claim Form is divided into 2 sections
Performing Provider Identification Number(PPIN)
Fee-for-Service
Group Provider Number
6. Request or message to remind a patient that the account is over due or delinquent
Aging Report
Appeal
Posting
Dun/Dunning
7. Listing service in their order of importance by dates of service and values. Highest charge to lowest charge
Global Period
Unarthorized Benefit
Withhold Incentive
Ranking Code
8. A report to track claim status of patient accounts and to identify individual accounts requiring additional workup for payments or write-offs
Claim Form is divided into 2 sections
Review
Suspended File Report
Aging Report
9. Take what insurance pays
TWIP
Global Period
Claim Form is divided into 2 sections
Remittance Advice(RA)
10. A report to track claim status of patient accounts and to identify individual accounts requiring additional workup for payments or write-offs
Aging Report
Coordination of Benefits (COB)
Assignment of Benefits
Bundling
11. Insurance company that bids for a contract with CMS to handle the Medicare program in a specific area
Inquiry
Fiscal Intermediary (FI)
Specificty
Life Cycle of Insurance Claims
12. Amount representing the charge most frequently used by a physician in a given periord of time
TWIP
Customary Charge
Allowed Charge
Posting
13. Conditions - situations - and services not covered by the insurance carrier
EPSDT
Itemized Statement
Exclusions and Limatations
Electronic Claim
14. Accounts that are subject to charges from time to time
Open Account
Group Practice
Conversion Factor
Global Procedures
15. Physician must obtain this number in order to practice within a state
Unarthorized Benefit
Collection Ratio
State License Number
Civil Monetary Penalities Law (CMPL)
16. Combing lesser services with a major service in order for one charge to include that variety of service
Profile
Fee Slip
Adjustment
Bundling
17. Working diagnosis which is not yet est.
Qualified Diagnosis
Paper Claims
Review
Aging Report
18. Promote interest and well being of the patients and residents of healthcare facility
Life Cycle of Insurance Claims
Component Billing
The Patient Care Partnership(Patients Bill of Rights)
Skip
19. Combing lesser services with a major service in order for one charge to include that variety of service
Bundling
Clearinghouse
Unarthorized Benefit
Skip
20. Specific time frames assigned to a code by an insurance comapny before additional payment will be made following a surgical procedure
Fee-for-Service
Adjustment
Global Period
Claim Form is divided into 2 sections
21. Record to track patients charges - payments - adjustments - and balance due
Ledger Card
Professional Courtesy
Provider Identification Number (PIN)
Coordination of Benefits (COB)
22. 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
Adjudicate
Collection Ratio
Fee-for-Service
Unarthorized Benefit
23. Agreement between the patoent and the physician regarding monthly installments to pay a bill
Correct Coding Initiative (CCI)
Truth in Lending
Component Billing
Global Procedures
24. Process of looking over a cliam to assess payment amounts
Group Provider Number
Adjustment Codes
Review
Global Period
25. Once claim is approved for payment Remittance Advice(RA) is sent to the provider and EOB is mailed to the policyholder
Assignment of Benefits
FECA
V.I. Payment
Group Practice
26. Discount or fee exception given to a patient at the discretion of the physician
Professional Courtesy
Provider Identification Number (PIN)
Unarthorized Benefit
Assignment of Benefits
27. Describes the service billed and includes a breakdown of how payment is determined
Insurance Adjustment(write off)
Explaination of Benefits
Claim Form is divided into 2 sections
Conversion Factor
28. Agreement between the patoent and the physician regarding monthly installments to pay a bill
Adjustment
TWIP
DMERC
Truth in Lending
29. Provider agrees to accept what insurance company approves as payment in full for the claim
Dun/Dunning
Assignment of Benefits
Accepted Assignments
Group Practice
30. Deferred or delayed processing method for inputting data a retrieval at a later date
Actual Charge
Claim Form is divided into 2 sections
Batching
Appeal
31. Physician has a seperate PPIN for each group/clinic in which they practices
Profile
Fee-for-Service
Performing Provider Identification Number(PPIN)
Insurance Adjustment(write off)
32. Listing of claims that have incorrect information such as posting error or missing information to process a claim
Suspended File Report
Professional Courtesy
Global Period
Encounter Form(Superbill)
33. Checking or tracing a claim sent to an insurance comapany to determine payment or processing status
Inquiry
Timely Filing Clause
DMERC
Claim Form is divided into 2 sections
34. Early and Periodic Screenings - Diagnosis - and Treatment
EPSDT
Specificty
Professional Courtesy
Timely Filing Clause
35. Assigned to the physician by Medicare program
Unique Provider Identification Number(UPIN)
Provider Identification Number (PIN)
Civil Monetary Penalities Law (CMPL)
Employer Indentification Number (EIN)
36. CMS 1500 - became effective July 2007 -All third party payers accept it - Medicare requires all physicians to use it
Universal Claim Form
Specificty
Conversion Factor
Actual Charge
37. Federal Employees' Compensation Act
FECA
Conversion Factor
Remittance Advice(RA)
Qualified Diagnosis
38. Bundling edits by CMS to combine various component items with a major service or procedure
Correct Coding Initiative (CCI)
Insurance Adjustment(write off)
Bundling
FECA
39. 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
Non-Covered Benefits
Global Procedures
Group Practice
Inquiry
40. Percent of payment held back for a risk account in the HMO program
Life Cycle of Insurance Claims
Withhold Incentive
Paper Claims
V.I. Payment
41. Authorization by a policyholder to allow a thrid-party payer to pay benefits to a health care provider
Assignment
Conversion Factor
Fiscal Intermediary (FI)
Fee Schedule
42. 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
Adjustment
Fiscal Intermediary (FI)
Medical Necessity Edit Checks
Basic Billing and Reimbursment Steps
43. Using ICD-9 codes to hughest degree
Professional Courtesy
Qualified Diagnosis
Assignment
Specificty
44. 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
Customary Charge
Adjustment
TWIP
Component Billing
45. Percent of payment held back for a risk account in the HMO program
Truth in Lending
EPSDT
Withhold Incentive
Commerical Payer
46. Durable Medical Equipment Regional Carrier
Assignment of Benefits
Component Billing
Group Provider Number
DMERC
47. CMS 1500 - became effective July 2007 -All third party payers accept it - Medicare requires all physicians to use it
Customary Charge
Posting
Universal Claim Form
Aging Accounts
48. Passed by the federal government to prosecute cases of Medicaid fraud
Claim Form is divided into 2 sections
Allowed Charge
DMERC
Civil Monetary Penalities Law (CMPL)
49. Promote interest and well being of the patients and residents of healthcare facility
Coding
The Patient Care Partnership(Patients Bill of Rights)
Skip
Fee Slip
50. Breaking the account receivable amounts into portions for billing at a specific date of the month
Global Period
Unique Provider Identification Number(UPIN)
Cycle Billing
Withhold Incentive