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






2. Take what insurance pays






3. Reimbursement directly sent from payer to provider






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






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






6. Take what insurance pays






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






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






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






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






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






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






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






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






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






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






18. 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






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






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






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






23. 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






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






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






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






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






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






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






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






31. 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






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






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






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






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






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






37. 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






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






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






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






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






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






43. 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






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






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






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






47. Early and Periodic Screenings - Diagnosis - and Treatment






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






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






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