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






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






3. Federal Employees' Compensation Act






4. Reimbursement directly sent from payer to provider






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






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






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






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






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






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






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






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






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






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






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






16. Term for processing payment






17. Working diagnosis which is not yet est.






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






19. 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






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






21. Statement of a patient's account history - showing DOS - detailed chrages - payments - day insurance claims was submitted - applicable adjusments - and account balances






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






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. 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






25. Take what insurance pays






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






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






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






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






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






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






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






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






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






35. 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'






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






37. Using ICD-9 codes to hughest degree






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






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






40. Term for processing payment






41. Reimbursement directly sent from payer to provider






42. 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






43. Amount charged by a practice when providing services






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






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






46. Durable Medical Equipment Regional Carrier






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






48. Assigned to the physician by Medicare program






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






50. Durable Medical Equipment Regional Carrier