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






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






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






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






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






6. 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






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






8. Checking or tracing a claim sent to an insurance comapany to determine payment or processing status






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






10. Federal Employees' Compensation Act






11. Federal Employees' Compensation Act






12. 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






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






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






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






16. Amount required by an insurance company that must be taken off a patient's acoount based on actual agreements and participation






17. 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






18. Term for processing payment






19. Amount required by an insurance company that must be taken off a patient's acoount based on actual agreements and participation






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






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






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






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






24. Term for processing payment






25. Conditions - situations - and services not covered by the insurance carrier






26. When two companies work together to decided payment of benefits






27. 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'






28. 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






29. Authorization by a policyholder to allow a thrid-party payer to pay benefits to a health care provider






30. Promote interest and well being of the patients and residents of healthcare facility






31. Codes used by insurance compaines to explain actions taken on a Remittance Notice






32. 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






33. Deferred or delayed processing method for inputting data a retrieval at a later date






34. Early and Periodic Screenings - Diagnosis - and Treatment






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






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






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






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






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






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






41. Major surgical procedures that typically have a follow-up period of 30 - 60 - 90 - 120 days






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






43. Passed by the federal government to prosecute cases of Medicaid fraud






44. Promote interest and well being of the patients and residents of healthcare facility






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






46. 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






47. Listing of claims that have incorrect information such as posting error or missing information to process a claim






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






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






50. Durable Medical Equipment Regional Carrier