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 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






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






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






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






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






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






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






8. 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






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






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






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






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






13. 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






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






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






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






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






18. 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'






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






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






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






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






23. Take what insurance pays






24. Amount charged by a practice when providing services






25. Assigned to the physician by Medicare program






26. Superbill or Encounter Form






27. Using ICD-9 codes to hughest degree






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






29. Early and Periodic Screenings - Diagnosis - and Treatment






30. Record to track patients charges - payments - adjustments - and balance due






31. 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






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






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






34. 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`






35. 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`






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






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






38. Major surgical procedures that typically have a follow-up period of 30 - 60 - 90 - 120 days






39. Working diagnosis which is not yet est.






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






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






42. 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






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






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






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






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






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






48. 1.Claims submission-transmission of claims data either electronically or manually to third party payers or clearinghouse for processing 2.Claims processing- thrid party payers and clearinghouse verify the information found and submitted claims about






49. Assigned to the physician by Medicare program






50. 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