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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. A report to track claim status of patient accounts and to identify individual accounts requiring additional workup for payments or write-offs
Health Care Clearinghouse
Group Provider Number
Aging Report
Unarthorized Benefit
2. Promote interest and well being of the patients and residents of healthcare facility
Bundling
The Patient Care Partnership(Patients Bill of Rights)
Customary Charge
Actual Charge
3. Passed by the federal government to prosecute cases of Medicaid fraud
Suspended File Report
Commerical Payer
Posting
Civil Monetary Penalities Law (CMPL)
4. The amount set by the carrier for the reimbursement of services
Dun/Dunning
Professional Courtesy
Allowed Charge
Correct Coding Initiative (CCI)
5. 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
Inquiry
V.I. Payment
Appeal
6. Agreement between the patoent and the physician regarding monthly installments to pay a bill
Group Provider Number
Fee Schedule
DMERC
Truth in Lending
7. Provider agrees to accept what insurance company approves as payment in full for the claim
Dun/Dunning
Dun/Dunning
Fiscal Intermediary (FI)
Accepted Assignments
8. Authorization by a policyholder to allow a thrid-party payer to pay benefits to a health care provider
Assignment
Ranking Code
Paper Claims
Open Account
9. Request sent to an insurance comapany or other payer asking that a submitted claim be reconsidered for payment or processing
Cycle Billing
Global Period
The Patient Care Partnership(Patients Bill of Rights)
Appeal
10. Analysis of accounts receivable that indicate delinquency of 60 - 90 - 120 days
Life Cycle of Insurance Claims
Aging Accounts
Appeal
Truth in Lending
11. Company that translates electroinc transactions between the standard formats and code set required under HIPAA and nonstandard formats and code sets
Employer Indentification Number (EIN)
Non-Covered Benefits
Health Care Clearinghouse
State License Number
12. 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
Life Cycle of Insurance Claims
Global Procedures
Itemized Statement
Medical Necessity
13. Superbill or Encounter Form
Commerical Payer
Fee Slip
Unique Provider Identification Number(UPIN)
Unit Count
14. Amount charged by a practice when providing services
Clearinghouse
Actual Charge
Ranking Code
Appeal
15. A report to track claim status of patient accounts and to identify individual accounts requiring additional workup for payments or write-offs
Non-Covered Benefits
Aging Report
Insurance Adjustment(write off)
Bundling
16. Reimbursement directly sent from payer to provider
Assignment of Benefits
Global Period
Basic Billing and Reimbursment Steps
Review
17. Durable Medical Equipment Regional Carrier
Allowed Charge
Dun/Dunning
DMERC
Assignment of Benefits
18. Statement of a patient's account history - showing DOS - detailed chrages - payments - day insurance claims was submitted - applicable adjusments - and account balances
Performing Provider Identification Number(PPIN)
Itemized Statement
Basic Billing and Reimbursment Steps
FECA
19. Request or message to remind a patient that the account is over due or delinquent
Dun/Dunning
Inquiry
Unique Provider Identification Number(UPIN)
Basic Billing and Reimbursment Steps
20. Analysis of accounts receivable that indicate delinquency of 60 - 90 - 120 days
Insurance Adjustment(write off)
Aging Accounts
Encounter Form(Superbill)
Basic Billing and Reimbursment Steps
21. Physician has a seperate PPIN for each group/clinic in which they practices
Collection Ratio
Posting
Adjustment
Performing Provider Identification Number(PPIN)
22. Accounts that are subject to charges from time to time
Open Account
Component Billing
Actual Charge
State License Number
23. Deferred or delayed processing method for inputting data a retrieval at a later date
Global Period
Batching
Clearinghouse
Unit Count
24. Established proce set by a medical practice for proefessional services
Aging Report
Utilization review
Accepted Assignments
Fee Schedule
25. Provider agrees to accept what insurance company approves as payment in full for the claim
Accepted Assignments
Paper Claims
Performing Provider Identification Number(PPIN)
Group Practice
26. Superbill or Encounter Form
Health Care Clearinghouse
Exclusions and Limatations
Fee Slip
Adjudicate
27. 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`
Performing Provider Identification Number(PPIN)
Truth in Lending
Paper Claims
Component Billing
28. Billing for each item service provided to a patient in accourdance with insurance carriers' policies
Ledger Card
Clearinghouse
Component Billing
Correct Coding Initiative (CCI)
29. Specific time frames assigned to a code by an insurance comapny before additional payment will be made following a surgical procedure
Global Period
Suspended File Report
Collection Ratio
Employer Indentification Number (EIN)
30. Request or message to remind a patient that the account is over due or delinquent
Actual Charge
Aging Accounts
Assignment
Dun/Dunning
31. Amount representing the charge most frequently used by a physician in a given periord of time
Customary Charge
Basic Billing and Reimbursment Steps
Exclusions and Limatations
Adjustment
32. Using ICD-9 codes to hughest degree
Profile
Specificty
Withhold Incentive
Electronic Claim
33. Federal Tax identification number - issued by internal revenue service -social security number used if employer doesn't have a EIN
Cycle Billing
Employer Indentification Number (EIN)
Customary Charge
Fee Schedule
34. Early and Periodic Screenings - Diagnosis - and Treatment
EPSDT
Itemized Statement
Medical Necessity Edit Checks
Batching
35. Private health insurance company or employer-based group insurance plan that pays claims for eligible participants
Adjustment
Commerical Payer
Aging Report
FECA
36. Private health insurance company or employer-based group insurance plan that pays claims for eligible participants
Commerical Payer
Coding
Electronic Claim
Timely Filing Clause
37. List of CPT codes used by a physician with a corresponding fee that is usually calculated and maintained by a third-party payer
Profile
Paper Claims
Truth in Lending
Posting
38. Checking or tracing a claim sent to an insurance comapany to determine payment or processing status
Dun/Dunning
Inquiry
Fee Schedule
Medical Necessity Edit Checks
39. 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
Group Practice
Professional Courtesy
Unarthorized Benefit
Ranking Code
40. Discount or fee exception given to a patient at the discretion of the physician
Professional Courtesy
The Patient Care Partnership(Patients Bill of Rights)
Electronic Claim
Universal Claim Form
41. Established proce set by a medical practice for proefessional services
Fee Schedule
Aging Report
Ledger Card
Clearinghouse
42. Describes the service billed and includes a breakdown of how payment is determined
Employer Indentification Number (EIN)
Withhold Incentive
Group Provider Number
Explaination of Benefits
43. Passed by the federal government to prosecute cases of Medicaid fraud
Adjustment Codes
Performing Provider Identification Number(PPIN)
Professional Courtesy
Civil Monetary Penalities Law (CMPL)
44. Listing of claims that have incorrect information such as posting error or missing information to process a claim
Customary Charge
Global Procedures
Provider Identification Number (PIN)
Suspended File Report
45. Process of converting diagnoses - procedures - and services into numeric and alpha-numeric characters
Coding
Life Cycle of Insurance Claims
Medical Necessity
Customary Charge
46. Working diagnosis which is not yet est.
Fee Slip
Correct Coding Initiative (CCI)
Coordination of Benefits (COB)
Qualified Diagnosis
47. Listing service in their order of importance by dates of service and values. Highest charge to lowest charge
Unique Provider Identification Number(UPIN)
Suspended File Report
The Patient Care Partnership(Patients Bill of Rights)
Ranking Code
48. Money amount determined by dividing the actual charge of a service or procedure by a relative unit
Conversion Factor
Suspended File Report
Withhold Incentive
DMERC
49. Request sent to an insurance comapany or other payer asking that a submitted claim be reconsidered for payment or processing
Appeal
Ranking Code
Fee-for-Service
Unit Count
50. Amount required by an insurance company that must be taken off a patient's acoount based on actual agreements and participation
Provider Identification Number (PIN)
Ledger Card
Insurance Adjustment(write off)
Itemized Statement