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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. Amount required by an insurance company that must be taken off a patient's acoount based on actual agreements and participation
Provider Identification Number (PIN)
Insurance Adjustment(write off)
Explaination of Benefits
Bundling
2. When two companies work together to decided payment of benefits
Coordination of Benefits (COB)
Claim Form is divided into 2 sections
Withhold Incentive
Inquiry
3. Means to report the number of times a service was provided on the same date of service to the same patient
Commerical Payer
Medical Necessity
Unit Count
Remittance Advice(RA)
4. Billing for each item service provided to a patient in accourdance with insurance carriers' policies
Component Billing
Suspended File Report
Cycle Billing
Non-Covered Benefits
5. Patient who owes a balance on the account who has moved without a forwarding address
Health Care Clearinghouse
Skip
Review
Performing Provider Identification Number(PPIN)
6. List of CPT codes used by a physician with a corresponding fee that is usually calculated and maintained by a third-party payer
Profile
Remittance Advice(RA)
Life Cycle of Insurance Claims
Employer Indentification Number (EIN)
7. Breaking the account receivable amounts into portions for billing at a specific date of the month
Cycle Billing
Bundling
Explaination of Benefits
Health Care Clearinghouse
8. Describes the service billed and includes a breakdown of how payment is determined
Explaination of Benefits
Collection Ratio
Clearinghouse
Skip
9. Take what insurance pays
TWIP
Cycle Billing
Coordination of Benefits (COB)
Conversion Factor
10. 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
Global Period
Timely Filing Clause
Adjustment
Adjudicate
11. 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
State License Number
Basic Billing and Reimbursment Steps
Commerical Payer
Life Cycle of Insurance Claims
12. Statement of a patient's account history - showing DOS - detailed chrages - payments - day insurance claims was submitted - applicable adjusments - and account balances
Itemized Statement
Correct Coding Initiative (CCI)
Dun/Dunning
Timely Filing Clause
13. Term for processing payment
FECA
Professional Courtesy
Cycle Billing
Adjudicate
14. Money amount determined by dividing the actual charge of a service or procedure by a relative unit
Performing Provider Identification Number(PPIN)
Conversion Factor
State License Number
Adjustment
15. 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
Medical Necessity Edit Checks
Unit Count
Cycle Billing
Encounter Form(Superbill)
16. Percent of payment held back for a risk account in the HMO program
Skip
Customary Charge
Withhold Incentive
Skip
17. Private health insurance company or employer-based group insurance plan that pays claims for eligible participants
State License Number
Customary Charge
Ledger Card
Commerical Payer
18. Take what insurance pays
Health Care Clearinghouse
Medical Necessity
TWIP
Assignment
19. Reimbursement directly sent from payer to provider
Correct Coding Initiative (CCI)
Coding
Assignment of Benefits
Coding
20. Codes used by insurance compaines to explain actions taken on a Remittance Notice
Suspended File Report
Adjustment Codes
Actual Charge
Unique Provider Identification Number(UPIN)
21. 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'
Timely Filing Clause
Medical Necessity
Utilization review
Aging Accounts
22. Private health insurance company or employer-based group insurance plan that pays claims for eligible participants
Profile
Insurance Adjustment(write off)
Performing Provider Identification Number(PPIN)
Commerical Payer
23. Federal Tax identification number - issued by internal revenue service -social security number used if employer doesn't have a EIN
Cycle Billing
Dun/Dunning
Itemized Statement
Employer Indentification Number (EIN)
24. Process of looking over a cliam to assess payment amounts
Batching
Profile
TWIP
Review
25. 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
Cycle Billing
Non-Covered Benefits
Truth in Lending
Collection Ratio
26. Physician must obtain this number in order to practice within a state
Qualified Diagnosis
EPSDT
State License Number
Coding
27. Number assigned by insurance companies to a physician who renders service to patients
Claim Form is divided into 2 sections
Provider Identification Number (PIN)
Assignment of Benefits
Group Practice
28. Physician has a seperate PPIN for each group/clinic in which they practices
Component Billing
TWIP
Coding
Performing Provider Identification Number(PPIN)
29. 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'
Employer Indentification Number (EIN)
Medical Necessity
Civil Monetary Penalities Law (CMPL)
Electronic Claim
30. 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
Electronic Claim
Paper Claims
Fee-for-Service
Peer Review Orginization (PRO)
31. Assigned to the physician by Medicare program
Paper Claims
Basic Billing and Reimbursment Steps
Unique Provider Identification Number(UPIN)
Skip
32. Passed by the federal government to prosecute cases of Medicaid fraud
Adjustment
Itemized Statement
Civil Monetary Penalities Law (CMPL)
Global Procedures
33. Superbill or Encounter Form
Correct Coding Initiative (CCI)
Fee Slip
Unarthorized Benefit
Component Billing
34. Reimbursement directly sent from payer to provider
Assignment of Benefits
Appeal
TWIP
Posting
35. List of CPT codes used by a physician with a corresponding fee that is usually calculated and maintained by a third-party payer
Unit Count
Customary Charge
Claim Form is divided into 2 sections
Profile
36. 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
Group Practice
Itemized Statement
Specificty
Medical Necessity Edit Checks
37. Amount of time allowed by an insurance company for a claim to be submitted for a payment from the date of service
State License Number
Timely Filing Clause
Fiscal Intermediary (FI)
Fee Slip
38. Insurance company that bids for a contract with CMS to handle the Medicare program in a specific area
Remittance Advice(RA)
Fiscal Intermediary (FI)
Performing Provider Identification Number(PPIN)
Claim Form is divided into 2 sections
39. Listing of diagnosis - procedures - and charges for a patients visit
Inquiry
State License Number
Encounter Form(Superbill)
Professional Courtesy
40. Federal Employees' Compensation Act
Customary Charge
Allowed Charge
FECA
Professional Courtesy
41. Analysis of accounts receivable that indicate delinquency of 60 - 90 - 120 days
Aging Accounts
Unique Provider Identification Number(UPIN)
Unit Count
Life Cycle of Insurance Claims
42. Listing service in their order of importance by dates of service and values. Highest charge to lowest charge
Skip
Ranking Code
Ledger Card
Global Procedures
43. 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)
Global Procedures
FECA
Claim Form is divided into 2 sections
44. 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
Group Provider Number
Medical Necessity
Employer Indentification Number (EIN)
Encounter Form(Superbill)
45. Provider agrees to accept what insurance company approves as payment in full for the claim
Fiscal Intermediary (FI)
Accepted Assignments
Truth in Lending
Coordination of Benefits (COB)
46. Patient who owes a balance on the account who has moved without a forwarding address
Performing Provider Identification Number(PPIN)
Unarthorized Benefit
Skip
Profile
47. Number assigned by insurance companies to a physician who renders service to patients
Provider Identification Number (PIN)
Coordination of Benefits (COB)
Fee Schedule
Universal Claim Form
48. CMS 1500 - became effective July 2007 -All third party payers accept it - Medicare requires all physicians to use it
Itemized Statement
Claim Form is divided into 2 sections
Peer Review Orginization (PRO)
Universal Claim Form
49. Percent of payment held back for a risk account in the HMO program
Global Period
Bundling
Actual Charge
Withhold Incentive
50. Request or message to remind a patient that the account is over due or delinquent
Appeal
Dun/Dunning
Insurance Adjustment(write off)
Performing Provider Identification Number(PPIN)