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. Discount or fee exception given to a patient at the discretion of the physician






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






3. Amount of time allowed by an insurance company for a claim to be submitted for a payment from the date of service






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






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






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






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






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






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






10. List of CPT codes used by a physician with a corresponding fee that is usually calculated and maintained by a third-party payer






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






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






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






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






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






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






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






18. List of CPT codes used by a physician with a corresponding fee that is usually calculated and maintained by a third-party payer






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






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






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






22. 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






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






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






25. 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






26. Federal Employees' Compensation Act






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






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






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






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






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






32. 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






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






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






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






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






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






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






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






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






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






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






43. Process of looking over a cliam to assess payment amounts






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






45. Process of looking over a cliam to assess payment amounts






46. 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






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






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






49. 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`






50. Amount of time allowed by an insurance company for a claim to be submitted for a payment from the date of service