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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. Money amount determined by dividing the actual charge of a service or procedure by a relative unit
Civil Monetary Penalities Law (CMPL)
Conversion Factor
Life Cycle of Insurance Claims
Suspended File Report
2. Authorization by a policyholder to allow a thrid-party payer to pay benefits to a health care provider
Health Care Clearinghouse
Claim Form is divided into 2 sections
DMERC
Assignment
3. Listing of claims that have incorrect information such as posting error or missing information to process a claim
Review
Suspended File Report
Unarthorized Benefit
Medical Necessity Edit Checks
4. Codes used by insurance compaines to explain actions taken on a Remittance Notice
Global Procedures
V.I. Payment
Adjustment Codes
Insurance Adjustment(write off)
5. Insurance company that bids for a contract with CMS to handle the Medicare program in a specific area
Open Account
Fiscal Intermediary (FI)
Component Billing
State License Number
6. Major surgical procedures that typically have a follow-up period of 30 - 60 - 90 - 120 days
Global Procedures
Specificty
Collection Ratio
Adjustment Codes
7. Listing of claims that have incorrect information such as posting error or missing information to process a claim
Performing Provider Identification Number(PPIN)
Correct Coding Initiative (CCI)
Timely Filing Clause
Suspended File Report
8. Superbill or Encounter Form
Fee Slip
Allowed Charge
Unit Count
Assignment of Benefits
9. Procedure or services provided without proper authorizationor was not covered by a current authorization -denied - provider can't bill patient for charges
Unarthorized Benefit
Itemized Statement
State License Number
Allowed Charge
10. Percent of payment held back for a risk account in the HMO program
Skip
Conversion Factor
Coding
Withhold Incentive
11. Physician must obtain this number in order to practice within a state
State License Number
V.I. Payment
FECA
Accepted Assignments
12. Codes used by insurance compaines to explain actions taken on a Remittance Notice
Timely Filing Clause
Adjustment Codes
Unique Provider Identification Number(UPIN)
Collection Ratio
13. 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'
Global Period
V.I. Payment
Allowed Charge
Medical Necessity
14. The amount set by the carrier for the reimbursement of services
Bundling
Allowed Charge
Medical Necessity Edit Checks
Utilization review
15. Patient who owes a balance on the account who has moved without a forwarding address
Ranking Code
Medical Necessity
Dun/Dunning
Skip
16. Combing lesser services with a major service in order for one charge to include that variety of service
Bundling
V.I. Payment
Aging Accounts
Batching
17. Procedure or services provided without proper authorizationor was not covered by a current authorization -denied - provider can't bill patient for charges
Unarthorized Benefit
Appeal
Assignment
Skip
18. 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`
Group Practice
V.I. Payment
Aging Accounts
Paper Claims
19. Means to report the number of times a service was provided on the same date of service to the same patient
Dun/Dunning
Unit Count
DMERC
Truth in Lending
20. Promote interest and well being of the patients and residents of healthcare facility
EPSDT
Medical Necessity Edit Checks
The Patient Care Partnership(Patients Bill of Rights)
Cycle Billing
21. Means to report the number of times a service was provided on the same date of service to the same patient
Commerical Payer
Actual Charge
Unit Count
Aging Accounts
22. Billing for each item service provided to a patient in accourdance with insurance carriers' policies
Coding
Component Billing
Skip
Peer Review Orginization (PRO)
23. Promote interest and well being of the patients and residents of healthcare facility
Assignment
DMERC
The Patient Care Partnership(Patients Bill of Rights)
Open Account
24. Breaking the account receivable amounts into portions for billing at a specific date of the month
Cycle Billing
Correct Coding Initiative (CCI)
Clearinghouse
Medical Necessity
25. Breaking the account receivable amounts into portions for billing at a specific date of the month
Skip
Dun/Dunning
Cycle Billing
Global Period
26. Amount required by an insurance company that must be taken off a patient's acoount based on actual agreements and participation
Commerical Payer
Clearinghouse
Insurance Adjustment(write off)
Conversion Factor
27. 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
Electronic Claim
Group Provider Number
Timely Filing Clause
FECA
28. Authorization by a policyholder to allow a thrid-party payer to pay benefits to a health care provider
Actual Charge
Professional Courtesy
Assignment
Non-Covered Benefits
29. State based group of physicians working under government guideline to review cases and determine their appropriateness and quality of professional care
Peer Review Orginization (PRO)
The Patient Care Partnership(Patients Bill of Rights)
Profile
Truth in Lending
30. Listing of diagnosis - procedures - and charges for a patients visit
Appeal
Clearinghouse
Encounter Form(Superbill)
Group Practice
31. CMS 1500 - became effective July 2007 -All third party payers accept it - Medicare requires all physicians to use it
Group Provider Number
Universal Claim Form
Encounter Form(Superbill)
Inquiry
32. Any procedure or service reported on insurance claim that is not listed in payer's master benefit list -results in denial -payers may be able tp recover charges
Non-Covered Benefits
Profile
Assignment
Itemized Statement
33. Physician has a seperate PPIN for each group/clinic in which they practices
Bundling
Coordination of Benefits (COB)
Component Billing
Performing Provider Identification Number(PPIN)
34. Patient who owes a balance on the account who has moved without a forwarding address
Utilization review
Open Account
Allowed Charge
Skip
35. 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
Employer Indentification Number (EIN)
Basic Billing and Reimbursment Steps
Component Billing
36. Amount charged by a practice when providing services
Non-Covered Benefits
Peer Review Orginization (PRO)
Assignment
Actual Charge
37. Listing of diagnosis - procedures - and charges for a patients visit
Inquiry
Basic Billing and Reimbursment Steps
Encounter Form(Superbill)
Unit Count
38. Amount charged by a practice when providing services
Unarthorized Benefit
Adjudicate
Actual Charge
Cycle Billing
39. A report to track claim status of patient accounts and to identify individual accounts requiring additional workup for payments or write-offs
Aging Report
Paper Claims
Commerical Payer
Non-Covered Benefits
40. Request sent to an insurance comapany or other payer asking that a submitted claim be reconsidered for payment or processing
Appeal
Remittance Advice(RA)
Medical Necessity
Fee Slip
41. Amount representing the charge most frequently used by a physician in a given periord of time
Assignment
Group Practice
Customary Charge
Encounter Form(Superbill)
42. List of CPT codes used by a physician with a corresponding fee that is usually calculated and maintained by a third-party payer
Civil Monetary Penalities Law (CMPL)
Peer Review Orginization (PRO)
Batching
Profile
43. Process of assesing medical services to assure medical necessity and the appropriateness of treatment
Utilization review
Coding
Allowed Charge
Universal Claim Form
44. Specific time frames assigned to a code by an insurance comapny before additional payment will be made following a surgical procedure
Profile
Truth in Lending
Global Period
Batching
45. Major surgical procedures that typically have a follow-up period of 30 - 60 - 90 - 120 days
Global Procedures
Aging Report
Ranking Code
Medical Necessity Edit Checks
46. Reimbursement directly sent from payer to provider
Actual Charge
Review
Assignment of Benefits
Adjustment
47. Checking or tracing a claim sent to an insurance comapany to determine payment or processing status
Global Period
Fiscal Intermediary (FI)
Employer Indentification Number (EIN)
Inquiry
48. Provider agrees to accept what insurance company approves as payment in full for the claim
Remittance Advice(RA)
Accepted Assignments
Peer Review Orginization (PRO)
Explaination of Benefits
49. State based group of physicians working under government guideline to review cases and determine their appropriateness and quality of professional care
DMERC
Paper Claims
Customary Charge
Peer Review Orginization (PRO)
50. Bundling edits by CMS to combine various component items with a major service or procedure
Coding
TWIP
Correct Coding Initiative (CCI)
Assignment