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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. 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
Unique Provider Identification Number(UPIN)
Clearinghouse
Dun/Dunning
Global Procedures
2. When two companies work together to decided payment of benefits
Coordination of Benefits (COB)
Component Billing
Aging Accounts
Encounter Form(Superbill)
3. Amount representing the charge most frequently used by a physician in a given periord of time
EPSDT
Collection Ratio
Customary Charge
Unit Count
4. 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
Group Practice
The Patient Care Partnership(Patients Bill of Rights)
Itemized Statement
Exclusions and Limatations
5. Assigned to the physician by Medicare program
Remittance Advice(RA)
Unique Provider Identification Number(UPIN)
Collection Ratio
Ledger Card
6. 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
Adjustment
Appeal
Unique Provider Identification Number(UPIN)
Aging Accounts
7. 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
Aging Accounts
Non-Covered Benefits
Encounter Form(Superbill)
V.I. Payment
8. Take what insurance pays
Insurance Adjustment(write off)
Review
Actual Charge
TWIP
9. 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'
Medical Necessity
Ledger Card
Peer Review Orginization (PRO)
Aging Report
10. Amount of time allowed by an insurance company for a claim to be submitted for a payment from the date of service
Timely Filing Clause
Adjustment
Civil Monetary Penalities Law (CMPL)
Exclusions and Limatations
11. Once claim is approved for payment Remittance Advice(RA) is sent to the provider and EOB is mailed to the policyholder
V.I. Payment
Aging Accounts
Fee-for-Service
Assignment
12. Reimbursement directly sent from payer to provider
The Patient Care Partnership(Patients Bill of Rights)
Assignment of Benefits
Encounter Form(Superbill)
Profile
13. Patient who owes a balance on the account who has moved without a forwarding address
Basic Billing and Reimbursment Steps
Assignment
Fee Slip
Skip
14. Deferred or delayed processing method for inputting data a retrieval at a later date
Medical Necessity
Utilization review
Explaination of Benefits
Batching
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
Collection Ratio
Suspended File Report
Non-Covered Benefits
16. Listing service in their order of importance by dates of service and values. Highest charge to lowest charge
Fee Schedule
Ranking Code
Fee-for-Service
DMERC
17. Listing service in their order of importance by dates of service and values. Highest charge to lowest charge
Inquiry
Performing Provider Identification Number(PPIN)
Ranking Code
Allowed Charge
18. Billing for each item service provided to a patient in accourdance with insurance carriers' policies
Fee-for-Service
Component Billing
Basic Billing and Reimbursment Steps
TWIP
19. Private health insurance company or employer-based group insurance plan that pays claims for eligible participants
Commerical Payer
Bundling
Unit Count
Adjustment
20. Federal Tax identification number - issued by internal revenue service -social security number used if employer doesn't have a EIN
Bundling
Employer Indentification Number (EIN)
Suspended File Report
Fiscal Intermediary (FI)
21. Money amount determined by dividing the actual charge of a service or procedure by a relative unit
Cycle Billing
Conversion Factor
Timely Filing Clause
Adjudicate
22. 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
V.I. Payment
Group Practice
Utilization review
DMERC
23. Relationship between the amount of money owed and the amount of money collected
Provider Identification Number (PIN)
Collection Ratio
Conversion Factor
Profile
24. Relationship between the amount of money owed and the amount of money collected
DMERC
The Patient Care Partnership(Patients Bill of Rights)
EPSDT
Collection Ratio
25. 1. Blocks 1-13=patient info 2.Blocks 14-33=physicians info
Claim Form is divided into 2 sections
Commerical Payer
Medical Necessity
Inquiry
26. Provider agrees to accept what insurance company approves as payment in full for the claim
Civil Monetary Penalities Law (CMPL)
Accepted Assignments
Claim Form is divided into 2 sections
Group Provider Number
27. State based group of physicians working under government guideline to review cases and determine their appropriateness and quality of professional care
TWIP
Explaination of Benefits
Peer Review Orginization (PRO)
Posting
28. Percent of payment held back for a risk account in the HMO program
Withhold Incentive
Bundling
Unit Count
Utilization review
29. Codes used by insurance compaines to explain actions taken on a Remittance Notice
Performing Provider Identification Number(PPIN)
Health Care Clearinghouse
Basic Billing and Reimbursment Steps
Adjustment Codes
30. Request sent to an insurance comapany or other payer asking that a submitted claim be reconsidered for payment or processing
Appeal
Aging Report
Clearinghouse
Utilization review
31. Deferred or delayed processing method for inputting data a retrieval at a later date
Adjudicate
Batching
Unarthorized Benefit
Global Period
32. Durable Medical Equipment Regional Carrier
Professional Courtesy
Paper Claims
DMERC
Insurance Adjustment(write off)
33. Process of converting diagnoses - procedures - and services into numeric and alpha-numeric characters
Coding
Employer Indentification Number (EIN)
Clearinghouse
Clearinghouse
34. 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
V.I. Payment
Appeal
Fee-for-Service
35. Company that translates electroinc transactions between the standard formats and code set required under HIPAA and nonstandard formats and code sets
Timely Filing Clause
Assignment
Unarthorized Benefit
Health Care Clearinghouse
36. Breaking the account receivable amounts into portions for billing at a specific date of the month
Cycle Billing
Provider Identification Number (PIN)
Assignment of Benefits
Itemized Statement
37. 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
Batching
Specificty
Clearinghouse
Aging Report
38. Checking or tracing a claim sent to an insurance comapany to determine payment or processing status
Life Cycle of Insurance Claims
Itemized Statement
Inquiry
Universal Claim Form
39. 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
Electronic Claim
Adjudicate
Unique Provider Identification Number(UPIN)
Health Care Clearinghouse
40. List of CPT codes used by a physician with a corresponding fee that is usually calculated and maintained by a third-party payer
Profile
Aging Report
TWIP
Medical Necessity
41. Using ICD-9 codes to hughest degree
Collection Ratio
Exclusions and Limatations
Electronic Claim
Specificty
42. Analysis of accounts receivable that indicate delinquency of 60 - 90 - 120 days
Aging Accounts
Exclusions and Limatations
Correct Coding Initiative (CCI)
V.I. Payment
43. Listing of diagnosis - procedures - and charges for a patients visit
Posting
Adjustment Codes
Employer Indentification Number (EIN)
Encounter Form(Superbill)
44. Breaking the account receivable amounts into portions for billing at a specific date of the month
Employer Indentification Number (EIN)
Cycle Billing
FECA
Collection Ratio
45. Combing lesser services with a major service in order for one charge to include that variety of service
Collection Ratio
EPSDT
Bundling
Coding
46. 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
Aging Accounts
Profile
Life Cycle of Insurance Claims
Remittance Advice(RA)
47. Passed by the federal government to prosecute cases of Medicaid fraud
Global Procedures
Civil Monetary Penalities Law (CMPL)
Bundling
Allowed Charge
48. Private health insurance company or employer-based group insurance plan that pays claims for eligible participants
Unarthorized Benefit
Ranking Code
Commerical Payer
Aging Accounts
49. Physician has a seperate PPIN for each group/clinic in which they practices
Provider Identification Number (PIN)
Skip
Performing Provider Identification Number(PPIN)
Adjustment Codes
50. Reimbursement directly sent from payer to provider
Unique Provider Identification Number(UPIN)
Batching
Assignment of Benefits
Appeal