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. Durable Medical Equipment Regional Carrier






2. Durable Medical Equipment Regional Carrier






3. Assigned to the physician by Medicare program






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






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






6. 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






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






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






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






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






11. 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`






12. 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






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






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






15. Request sent to an insurance comapany or other payer asking that a submitted claim be reconsidered for payment or processing






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






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






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






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






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






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






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






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






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






25. 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`






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






27. Bundling edits by CMS to combine various component items with a major service or procedure






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






29. Request sent to an insurance comapany or other payer asking that a submitted claim be reconsidered for payment or processing






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






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






32. 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'






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






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






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






36. Term for processing payment






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






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






39. 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






40. Amount charged by a practice when providing services






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






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






43. Reimbursement directly sent from payer to provider






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






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






46. Assigned to the physician by Medicare program






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






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






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






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