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






2. 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






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






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






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






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






7. Process of assesing medical services to assure medical necessity and the appropriateness of treatment






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






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






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






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






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






13. Describes the service billed and includes a breakdown of how payment is determined






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






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






16. 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






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






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






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






20. Durable Medical Equipment Regional Carrier






21. Assigned to the physician by Medicare program






22. Insurance company that bids for a contract with CMS to handle the Medicare program in a specific area






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






24. Using ICD-9 codes to hughest degree






25. Amount charged by a practice when providing services






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






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






28. Accounts that are subject to charges from time to time






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






30. Amount charged by a practice when providing services






31. 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






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






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






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






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






36. Working diagnosis which is not yet est.






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






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






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






40. Listing of diagnosis - procedures - and charges for a patients visit






41. Using ICD-9 codes to hughest degree






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






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






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






45. 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






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. Insurance company that bids for a contract with CMS to handle the Medicare program in a specific area






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






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






50. 1. Blocks 1-13=patient info 2.Blocks 14-33=physicians info