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Test your basic knowledge |
Medical Billing Claims Basics
Start Test
Study First
Subject
:
medical-transcription
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. 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
Professional Courtesy
Insurance Adjustment(write off)
Skip
Basic Billing and Reimbursment Steps
2. 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
Medical Necessity Edit Checks
Encounter Form(Superbill)
Dun/Dunning
Utilization review
3. Process of looking over a cliam to assess payment amounts
Collection Ratio
Review
Insurance Adjustment(write off)
Encounter Form(Superbill)
4. Listing service in their order of importance by dates of service and values. Highest charge to lowest charge
Ranking Code
Suspended File Report
Qualified Diagnosis
EPSDT
5. 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
Appeal
Allowed Charge
Timely Filing Clause
Fee-for-Service
6. Request or message to remind a patient that the account is over due or delinquent
Non-Covered Benefits
Ledger Card
Dun/Dunning
Provider Identification Number (PIN)
7. Provider agrees to accept what insurance company approves as payment in full for the claim
Unarthorized Benefit
Adjustment Codes
Coordination of Benefits (COB)
Accepted Assignments
8. Amount representing the charge most frequently used by a physician in a given periord of time
Adjustment Codes
Dun/Dunning
Posting
Customary Charge
9. Superbill or Encounter Form
Cycle Billing
The Patient Care Partnership(Patients Bill of Rights)
Fee Slip
Aging Accounts
10. Insurance company that bids for a contract with CMS to handle the Medicare program in a specific area
Bundling
Coding
Fiscal Intermediary (FI)
Customary Charge
11. Billing for each item service provided to a patient in accourdance with insurance carriers' policies
Insurance Adjustment(write off)
Skip
Component Billing
Review
12. Reimbursement directly sent from payer to provider
Group Provider Number
Adjustment
Assignment of Benefits
Adjudicate
13. Reimbursement directly sent from payer to provider
Batching
Assignment of Benefits
Paper Claims
State License Number
14. 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
Employer Indentification Number (EIN)
The Patient Care Partnership(Patients Bill of Rights)
Universal Claim Form
Clearinghouse
15. Passed by the federal government to prosecute cases of Medicaid fraud
Electronic Claim
Civil Monetary Penalities Law (CMPL)
Open Account
Assignment
16. Private health insurance company or employer-based group insurance plan that pays claims for eligible participants
Commerical Payer
Ledger Card
Accepted Assignments
TWIP
17. Listing of claims that have incorrect information such as posting error or missing information to process a claim
Performing Provider Identification Number(PPIN)
Suspended File Report
Dun/Dunning
Professional Courtesy
18. Statement of a patient's account history - showing DOS - detailed chrages - payments - day insurance claims was submitted - applicable adjusments - and account balances
Fee Slip
Itemized Statement
Accepted Assignments
Component Billing
19. Provider agrees to accept what insurance company approves as payment in full for the claim
Accepted Assignments
Adjudicate
Universal Claim Form
Coordination of Benefits (COB)
20. Using ICD-9 codes to hughest degree
Paper Claims
Actual Charge
Assignment of Benefits
Specificty
21. Relationship between the amount of money owed and the amount of money collected
Collection Ratio
Remittance Advice(RA)
Correct Coding Initiative (CCI)
Specificty
22. Physician has a seperate PPIN for each group/clinic in which they practices
Bundling
Component Billing
Peer Review Orginization (PRO)
Performing Provider Identification Number(PPIN)
23. Listing of claims that have incorrect information such as posting error or missing information to process a claim
Suspended File Report
Non-Covered Benefits
Withhold Incentive
Appeal
24. Amount representing the charge most frequently used by a physician in a given periord of time
Component Billing
Actual Charge
Employer Indentification Number (EIN)
Customary Charge
25. Process or tansferring account information from a journal to a ledger
Health Care Clearinghouse
Posting
TWIP
Civil Monetary Penalities Law (CMPL)
26. Describes the service billed and includes a breakdown of how payment is determined
Explaination of Benefits
Peer Review Orginization (PRO)
Health Care Clearinghouse
Actual Charge
27. Number assigned by insurance companies to a physician who renders service to patients
Professional Courtesy
Provider Identification Number (PIN)
Withhold Incentive
Global Procedures
28. Codes used by insurance compaines to explain actions taken on a Remittance Notice
Fiscal Intermediary (FI)
Qualified Diagnosis
Electronic Claim
Adjustment Codes
29. Private health insurance company or employer-based group insurance plan that pays claims for eligible participants
Electronic Claim
Commerical Payer
Qualified Diagnosis
Component Billing
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
Unarthorized Benefit
Assignment
Electronic Claim
Correct Coding Initiative (CCI)
31. 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'
Posting
Medical Necessity
Commerical Payer
Assignment of Benefits
32. Conditions - situations - and services not covered by the insurance carrier
Insurance Adjustment(write off)
Customary Charge
Itemized Statement
Exclusions and Limatations
33. Describes the service billed and includes a breakdown of how payment is determined
Review
Health Care Clearinghouse
Explaination of Benefits
Coordination of Benefits (COB)
34. Federal Tax identification number - issued by internal revenue service -social security number used if employer doesn't have a EIN
Employer Indentification Number (EIN)
Professional Courtesy
Dun/Dunning
Conversion Factor
35. Established proce set by a medical practice for proefessional services
Unarthorized Benefit
Ranking Code
Fee Schedule
Fee-for-Service
36. 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'
Unit Count
Non-Covered Benefits
Medical Necessity
Adjudicate
37. A report to track claim status of patient accounts and to identify individual accounts requiring additional workup for payments or write-offs
Electronic Claim
Medical Necessity
Aging Report
Open Account
38. Specific time frames assigned to a code by an insurance comapny before additional payment will be made following a surgical procedure
Global Period
Profile
Electronic Claim
Encounter Form(Superbill)
39. Patient who owes a balance on the account who has moved without a forwarding address
Unarthorized Benefit
Skip
Paper Claims
Medical Necessity
40. The amount set by the carrier for the reimbursement of services
Insurance Adjustment(write off)
Allowed Charge
Unique Provider Identification Number(UPIN)
Component Billing
41. Working diagnosis which is not yet est.
Fiscal Intermediary (FI)
Claim Form is divided into 2 sections
Qualified Diagnosis
Ledger Card
42. Term for processing payment
Fee Slip
Adjudicate
Batching
Group Practice
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
Fee-for-Service
Coordination of Benefits (COB)
Exclusions and Limatations
Remittance Advice(RA)
44. Patient who owes a balance on the account who has moved without a forwarding address
Unit Count
Group Practice
Skip
Fee-for-Service
45. 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`
Paper Claims
Utilization review
Profile
Dun/Dunning
46. Combing lesser services with a major service in order for one charge to include that variety of service
Medical Necessity Edit Checks
Adjustment
Non-Covered Benefits
Bundling
47. Codes used by insurance compaines to explain actions taken on a Remittance Notice
Adjustment Codes
Insurance Adjustment(write off)
Life Cycle of Insurance Claims
Provider Identification Number (PIN)
48. Amount charged by a practice when providing services
Actual Charge
State License Number
Fee Slip
Specificty
49. Conditions - situations - and services not covered by the insurance carrier
Correct Coding Initiative (CCI)
Adjudicate
Group Practice
Exclusions and Limatations
50. Specific time frames assigned to a code by an insurance comapny before additional payment will be made following a surgical procedure
Global Period
Conversion Factor
Suspended File Report
Aging Report