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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. 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
Professional Courtesy
V.I. Payment
Group Provider Number
Medical Necessity Edit Checks
2. Codes used by insurance compaines to explain actions taken on a Remittance Notice
Utilization review
Conversion Factor
Adjustment Codes
Ranking Code
3. Amount of time allowed by an insurance company for a claim to be submitted for a payment from the date of service
Electronic Claim
Coding
Timely Filing Clause
Fee Schedule
4. Federal Employees' Compensation Act
Customary Charge
Fee Slip
FECA
Electronic Claim
5. Superbill or Encounter Form
Qualified Diagnosis
Specificty
Fee Slip
Ranking Code
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
Civil Monetary Penalities Law (CMPL)
Fee-for-Service
Unique Provider Identification Number(UPIN)
Fiscal Intermediary (FI)
7. State based group of physicians working under government guideline to review cases and determine their appropriateness and quality of professional care
Medical Necessity
Fiscal Intermediary (FI)
Aging Report
Peer Review Orginization (PRO)
8. Take what insurance pays
Actual Charge
Group Provider Number
TWIP
Health Care Clearinghouse
9. 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
Commerical Payer
State License Number
Clearinghouse
Timely Filing Clause
10. Major surgical procedures that typically have a follow-up period of 30 - 60 - 90 - 120 days
Global Procedures
Open Account
Non-Covered Benefits
Basic Billing and Reimbursment Steps
11. Early and Periodic Screenings - Diagnosis - and Treatment
Paper Claims
Bundling
Conversion Factor
EPSDT
12. Major surgical procedures that typically have a follow-up period of 30 - 60 - 90 - 120 days
Peer Review Orginization (PRO)
Review
Assignment
Global Procedures
13. Breaking the account receivable amounts into portions for billing at a specific date of the month
Encounter Form(Superbill)
Cycle Billing
DMERC
Explaination of Benefits
14. Process of assesing medical services to assure medical necessity and the appropriateness of treatment
Inquiry
Medical Necessity Edit Checks
Utilization review
Performing Provider Identification Number(PPIN)
15. Listing service in their order of importance by dates of service and values. Highest charge to lowest charge
Ranking Code
Review
Timely Filing Clause
Unique Provider Identification Number(UPIN)
16. Established proce set by a medical practice for proefessional services
Fee Slip
Global Period
Adjustment Codes
Fee Schedule
17. Listing of claims that have incorrect information such as posting error or missing information to process a claim
Employer Indentification Number (EIN)
Universal Claim Form
Suspended File Report
Medical Necessity Edit Checks
18. Billing for each item service provided to a patient in accourdance with insurance carriers' policies
Adjustment Codes
Aging Report
DMERC
Component Billing
19. Amount representing the charge most frequently used by a physician in a given periord of time
Customary Charge
Truth in Lending
Medical Necessity
Non-Covered Benefits
20. Amount charged by a practice when providing services
Correct Coding Initiative (CCI)
Withhold Incentive
Actual Charge
Exclusions and Limatations
21. Number assigned by insurance companies to a physician who renders service to patients
Cycle Billing
Provider Identification Number (PIN)
Basic Billing and Reimbursment Steps
Universal Claim Form
22. Provider agrees to accept what insurance company approves as payment in full for the claim
Inquiry
Accepted Assignments
Insurance Adjustment(write off)
Cycle Billing
23. 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
Adjustment Codes
Coordination of Benefits (COB)
Claim Form is divided into 2 sections
24. Request or message to remind a patient that the account is over due or delinquent
Coordination of Benefits (COB)
Component Billing
Dun/Dunning
Correct Coding Initiative (CCI)
25. Combing lesser services with a major service in order for one charge to include that variety of service
Electronic Claim
Aging Accounts
Bundling
Itemized Statement
26. Percent of payment held back for a risk account in the HMO program
Correct Coding Initiative (CCI)
Provider Identification Number (PIN)
Correct Coding Initiative (CCI)
Withhold Incentive
27. Insurance company that bids for a contract with CMS to handle the Medicare program in a specific area
Fee-for-Service
Fee Schedule
Assignment
Fiscal Intermediary (FI)
28. Relationship between the amount of money owed and the amount of money collected
Inquiry
Cycle Billing
Paper Claims
Collection Ratio
29. State based group of physicians working under government guideline to review cases and determine their appropriateness and quality of professional care
Customary Charge
Peer Review Orginization (PRO)
Ledger Card
Explaination of Benefits
30. Describes the service billed and includes a breakdown of how payment is determined
Global Period
Explaination of Benefits
Posting
Group Practice
31. Process or tansferring account information from a journal to a ledger
Correct Coding Initiative (CCI)
V.I. Payment
Fee-for-Service
Posting
32. 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
TWIP
Electronic Claim
Exclusions and Limatations
Group Practice
33. Authorization by a policyholder to allow a thrid-party payer to pay benefits to a health care provider
Profile
Life Cycle of Insurance Claims
DMERC
Assignment
34. Discount or fee exception given to a patient at the discretion of the physician
Fee-for-Service
Non-Covered Benefits
Professional Courtesy
Customary Charge
35. Listing of diagnosis - procedures - and charges for a patients visit
V.I. Payment
Encounter Form(Superbill)
Explaination of Benefits
Assignment
36. Working diagnosis which is not yet est.
Life Cycle of Insurance Claims
FECA
Peer Review Orginization (PRO)
Qualified Diagnosis
37. Once claim is approved for payment Remittance Advice(RA) is sent to the provider and EOB is mailed to the policyholder
Adjustment Codes
Insurance Adjustment(write off)
V.I. Payment
Fee Schedule
38. Accounts that are subject to charges from time to time
Open Account
Customary Charge
Aging Report
EPSDT
39. 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`
Clearinghouse
Inquiry
Paper Claims
Accepted Assignments
40. Process or tansferring account information from a journal to a ledger
Fiscal Intermediary (FI)
Performing Provider Identification Number(PPIN)
Remittance Advice(RA)
Posting
41. Durable Medical Equipment Regional Carrier
Electronic Claim
Medical Necessity
DMERC
Profile
42. Working diagnosis which is not yet est.
Fee Schedule
Suspended File Report
Qualified Diagnosis
Universal Claim Form
43. Record to track patients charges - payments - adjustments - and balance due
Collection Ratio
Profile
Batching
Ledger Card
44. Once claim is approved for payment Remittance Advice(RA) is sent to the provider and EOB is mailed to the policyholder
State License Number
V.I. Payment
Performing Provider Identification Number(PPIN)
Qualified Diagnosis
45. 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
Adjustment
Qualified Diagnosis
Fee-for-Service
Professional Courtesy
46. Physician has a seperate PPIN for each group/clinic in which they practices
Performing Provider Identification Number(PPIN)
Fee-for-Service
Electronic Claim
Peer Review Orginization (PRO)
47. The amount set by the carrier for the reimbursement of services
Bundling
Allowed Charge
Clearinghouse
Employer Indentification Number (EIN)
48. Discount or fee exception given to a patient at the discretion of the physician
Posting
Claim Form is divided into 2 sections
Profile
Professional Courtesy
49. Deferred or delayed processing method for inputting data a retrieval at a later date
Professional Courtesy
Batching
Inquiry
Conversion Factor
50. Means to report the number of times a service was provided on the same date of service to the same patient
Inquiry
V.I. Payment
DMERC
Unit Count