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






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






3. Durable Medical Equipment Regional Carrier






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






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






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






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






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






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






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






11. 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'






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






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






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






15. 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






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






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






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






19. 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






20. 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`






21. Federal Employees' Compensation Act






22. Amount charged by a practice when providing services






23. Term for processing payment






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






25. Using ICD-9 codes to hughest degree






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






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






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






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






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






31. Codes used by insurance compaines to explain actions taken on a Remittance Notice






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






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






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






35. 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






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






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






38. 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






39. 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






40. Take what insurance pays






41. Take what insurance pays






42. Assigned to the physician by Medicare program






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






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






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






46. Reimbursement directly sent from payer to provider






47. Federal Employees' Compensation Act






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






49. Assigned to the physician by Medicare program






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