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. Accounts that are subject to charges from time to time






2. 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






3. Durable Medical Equipment Regional Carrier






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






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






6. Superbill or Encounter Form






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






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






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






10. Traditional method ised by providers for submissions of charges to insurance companies -CMS 1500 -few plans accept encounter forms Medicare will only acccept CMS 1500`






11. Amount of time allowed by an insurance company for a claim to be submitted for a payment from the date of service






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






13. Amount charged by a practice when providing services






14. Superbill or Encounter Form






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






16. 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






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






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






19. Early and Periodic Screenings - Diagnosis - and Treatment






20. 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






21. Working diagnosis which is not yet est.






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






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






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






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






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






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






28. 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






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






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






31. Combing lesser services with a major service in order for one charge to include that variety of service






32. Company that translates electroinc transactions between the standard formats and code set required under HIPAA and nonstandard formats and code sets






33. 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






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






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






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






37. Assigned to the physician by Medicare program






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






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






40. 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






41. Procedure or services provided without proper authorizationor was not covered by a current authorization -denied - provider can't bill patient for charges






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






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






44. Using ICD-9 codes to hughest degree






45. 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






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






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






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






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






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