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






2. Working diagnosis which is not yet est.






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






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






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






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






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






8. Alternative to paper claims submitted to the third-party payer directly by the physician or through clearinghouse -paid faster and software has self-editing detects and reports entries may cause to be rejected






9. 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






10. Term for processing payment






11. Assigned to the physician by Medicare program






12. Amount charged by a practice when providing services






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






14. Term for processing payment






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






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






17. 1.Collect patients info 2.Verifying Insurance 3.Prepare the encounter form 4.Code the diagnosis and procedures 5.Review linkage and compliance 6.Calculate physicians charges 7.Prepare Claims 8.Transmit claims 9.payer adjudication 10.Follow up on reim






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






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






20. Reimbursement directly sent from payer to provider






21. 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






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






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






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






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






26. Take what insurance pays






27. 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






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






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






30. 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






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






32. 1.Collect patients info 2.Verifying Insurance 3.Prepare the encounter form 4.Code the diagnosis and procedures 5.Review linkage and compliance 6.Calculate physicians charges 7.Prepare Claims 8.Transmit claims 9.payer adjudication 10.Follow up on reim






33. Federal Employees' Compensation Act






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






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






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






37. Assigned to the physician by Medicare program






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






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






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






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






42. Early and Periodic Screenings - Diagnosis - and Treatment






43. Statement of a patient's account history - showing DOS - detailed chrages - payments - day insurance claims was submitted - applicable adjusments - and account balances






44. 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






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






46. 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






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






48. Once claim is approved for payment Remittance Advice(RA) is sent to the provider and EOB is mailed to the policyholder






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






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