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






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






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






4. Means to report the number of times a service was provided on the same date of service to the same patient






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






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






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






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






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






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






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






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






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






14. Company that translates electroinc transactions between the standard formats and code set required under HIPAA and nonstandard formats and code sets






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






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






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






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






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. Using ICD-9 codes to hughest degree






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






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






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






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






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






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






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






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






29. 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






30. 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






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






32. Working diagnosis which is not yet est.






33. 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






34. Durable Medical Equipment Regional Carrier






35. 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






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






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






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






39. Federal Employees' Compensation Act






40. Assigned to the physician by Medicare program






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






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






43. Superbill or Encounter Form






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






45. Term for processing payment






46. 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






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






48. 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






49. Reimbursement directly sent from payer to provider






50. Amount charged by a practice when providing services