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






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






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






4. 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






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






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






7. Take what insurance pays






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






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






10. 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`






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






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






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






14. 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






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






16. Early and Periodic Screenings - Diagnosis - and Treatment






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






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






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






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






21. 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






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






23. 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






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






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






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






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






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






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






30. Using ICD-9 codes to hughest degree






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






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






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






34. Term for processing payment






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






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






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






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






39. Amount charged by a practice when providing services






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






41. Assigned to the physician by Medicare program






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






43. 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






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






45. 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






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






47. Durable Medical Equipment Regional Carrier






48. Patient who owes a balance on the account who has moved without a forwarding address






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






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