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. Amount charged by a practice when providing services






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






3. Record to track patients charges - payments - adjustments - and balance due






4. 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






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






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






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






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






9. 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






10. 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






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






12. Private health insurance company or employer-based group insurance plan that pays claims for eligible participants






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






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






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






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






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






18. 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






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






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






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






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






23. Durable Medical Equipment Regional Carrier






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






25. 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






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






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






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






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






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






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






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






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






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






35. Electronic or paper-based report of payment sent by the payer to the provider






36. Superbill or Encounter Form






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






38. Durable Medical Equipment Regional Carrier






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






40. Federal Employees' Compensation Act






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






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






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






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






45. Take what insurance pays






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






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






48. Using ICD-9 codes to hughest degree






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






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