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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. 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
Aging Accounts
Claim Form is divided into 2 sections
Medical Necessity
Medical Necessity Edit Checks
2. Conditions - situations - and services not covered by the insurance carrier
Ranking Code
Global Procedures
Universal Claim Form
Exclusions and Limatations
3. Accounts that are subject to charges from time to time
Open Account
Bundling
FECA
Batching
4. Request sent to an insurance comapany or other payer asking that a submitted claim be reconsidered for payment or processing
TWIP
Appeal
Electronic Claim
Component Billing
5. Major surgical procedures that typically have a follow-up period of 30 - 60 - 90 - 120 days
Global Procedures
Claim Form is divided into 2 sections
Suspended File Report
Qualified Diagnosis
6. 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
Life Cycle of Insurance Claims
Accepted Assignments
Group Provider Number
Conversion Factor
7. Assigned to the physician by Medicare program
Coding
Unique Provider Identification Number(UPIN)
Specificty
Collection Ratio
8. 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
Health Care Clearinghouse
Peer Review Orginization (PRO)
Accepted Assignments
Adjustment
9. Amount representing the charge most frequently used by a physician in a given periord of time
Customary Charge
Fee Slip
Fee Schedule
Inquiry
10. Analysis of accounts receivable that indicate delinquency of 60 - 90 - 120 days
Global Period
Explaination of Benefits
Allowed Charge
Aging Accounts
11. Process of looking over a cliam to assess payment amounts
State License Number
State License Number
Review
Utilization review
12. Amount charged by a practice when providing services
Fee-for-Service
Actual Charge
Qualified Diagnosis
Basic Billing and Reimbursment Steps
13. CMS 1500 - became effective July 2007 -All third party payers accept it - Medicare requires all physicians to use it
Adjustment Codes
Utilization review
Universal Claim Form
Basic Billing and Reimbursment Steps
14. Insurance company that bids for a contract with CMS to handle the Medicare program in a specific area
DMERC
Component Billing
Fiscal Intermediary (FI)
Electronic Claim
15. Describes the service billed and includes a breakdown of how payment is determined
Fiscal Intermediary (FI)
Component Billing
Insurance Adjustment(write off)
Explaination of Benefits
16. Billing for each item service provided to a patient in accourdance with insurance carriers' policies
Component Billing
Unique Provider Identification Number(UPIN)
Utilization review
Civil Monetary Penalities Law (CMPL)
17. Once claim is approved for payment Remittance Advice(RA) is sent to the provider and EOB is mailed to the policyholder
Clearinghouse
EPSDT
V.I. Payment
Group Practice
18. Major surgical procedures that typically have a follow-up period of 30 - 60 - 90 - 120 days
Encounter Form(Superbill)
Timely Filing Clause
Unarthorized Benefit
Global Procedures
19. Bundling edits by CMS to combine various component items with a major service or procedure
Group Practice
Correct Coding Initiative (CCI)
Coordination of Benefits (COB)
Professional Courtesy
20. 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
Fee-for-Service
Peer Review Orginization (PRO)
Peer Review Orginization (PRO)
Group Practice
21. Once claim is approved for payment Remittance Advice(RA) is sent to the provider and EOB is mailed to the policyholder
Unique Provider Identification Number(UPIN)
V.I. Payment
Actual Charge
Dun/Dunning
22. Listing of diagnosis - procedures - and charges for a patients visit
Basic Billing and Reimbursment Steps
FECA
Adjustment Codes
Encounter Form(Superbill)
23. 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'
Inquiry
Review
Electronic Claim
Medical Necessity
24. Early and Periodic Screenings - Diagnosis - and Treatment
Ranking Code
Dun/Dunning
Clearinghouse
EPSDT
25. Promote interest and well being of the patients and residents of healthcare facility
Adjustment Codes
The Patient Care Partnership(Patients Bill of Rights)
Coordination of Benefits (COB)
Remittance Advice(RA)
26. Physician must obtain this number in order to practice within a state
DMERC
Explaination of Benefits
TWIP
State License Number
27. Process of assesing medical services to assure medical necessity and the appropriateness of treatment
Encounter Form(Superbill)
Customary Charge
Utilization review
Adjustment Codes
28. Superbill or Encounter Form
Fee Slip
Aging Accounts
Actual Charge
Customary Charge
29. State based group of physicians working under government guideline to review cases and determine their appropriateness and quality of professional care
DMERC
Itemized Statement
State License Number
Peer Review Orginization (PRO)
30. Listing service in their order of importance by dates of service and values. Highest charge to lowest charge
Itemized Statement
TWIP
Batching
Ranking Code
31. 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
Clearinghouse
Non-Covered Benefits
Adjudicate
Group Provider Number
32. Company that translates electroinc transactions between the standard formats and code set required under HIPAA and nonstandard formats and code sets
Health Care Clearinghouse
Customary Charge
Cycle Billing
Global Period
33. 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
Adjustment
Adjustment Codes
Life Cycle of Insurance Claims
Medical Necessity Edit Checks
34. 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
Basic Billing and Reimbursment Steps
Bundling
Timely Filing Clause
35. Electronic or paper-based report of payment sent by the payer to the provider
Specificty
Allowed Charge
Fee Schedule
Remittance Advice(RA)
36. Federal Tax identification number - issued by internal revenue service -social security number used if employer doesn't have a EIN
Professional Courtesy
Employer Indentification Number (EIN)
Adjustment Codes
Itemized Statement
37. Discount or fee exception given to a patient at the discretion of the physician
Professional Courtesy
Health Care Clearinghouse
Commerical Payer
Electronic Claim
38. List of CPT codes used by a physician with a corresponding fee that is usually calculated and maintained by a third-party payer
Basic Billing and Reimbursment Steps
Aging Accounts
Group Practice
Profile
39. Physician has a seperate PPIN for each group/clinic in which they practices
Paper Claims
Open Account
Performing Provider Identification Number(PPIN)
Non-Covered Benefits
40. 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
Timely Filing Clause
Life Cycle of Insurance Claims
Unit Count
Timely Filing Clause
41. Specific time frames assigned to a code by an insurance comapny before additional payment will be made following a surgical procedure
DMERC
State License Number
Global Period
Aging Accounts
42. Assigned to the physician by Medicare program
Health Care Clearinghouse
Allowed Charge
Life Cycle of Insurance Claims
Unique Provider Identification Number(UPIN)
43. Established proce set by a medical practice for proefessional services
Dun/Dunning
Global Procedures
Employer Indentification Number (EIN)
Fee Schedule
44. Physician must obtain this number in order to practice within a state
Aging Report
Remittance Advice(RA)
Employer Indentification Number (EIN)
State License Number
45. Amount of time allowed by an insurance company for a claim to be submitted for a payment from the date of service
Timely Filing Clause
State License Number
Coordination of Benefits (COB)
TWIP
46. Take what insurance pays
Professional Courtesy
TWIP
V.I. Payment
Fiscal Intermediary (FI)
47. Amount required by an insurance company that must be taken off a patient's acoount based on actual agreements and participation
Insurance Adjustment(write off)
Fee Slip
Allowed Charge
TWIP
48. 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
Coordination of Benefits (COB)
Paper Claims
Fee-for-Service
Adjudicate
49. Codes used by insurance compaines to explain actions taken on a Remittance Notice
Bundling
Provider Identification Number (PIN)
Adjustment Codes
Adjudicate
50. Specific time frames assigned to a code by an insurance comapny before additional payment will be made following a surgical procedure
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Professional Courtesy
Global Period
Peer Review Orginization (PRO)