SUBJECTS
|
BROWSE
|
CAREER CENTER
|
POPULAR
|
JOIN
|
LOGIN
Business Skills
|
Soft Skills
|
Basic Literacy
|
Certifications
About
|
Help
|
Privacy
|
Terms
Search
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. Breaking the account receivable amounts into portions for billing at a specific date of the month
Cycle Billing
Aging Report
Truth in Lending
Posting
2. Record to track patients charges - payments - adjustments - and balance due
Ledger Card
Coordination of Benefits (COB)
Accepted Assignments
Assignment of Benefits
3. Billing for each item service provided to a patient in accourdance with insurance carriers' policies
Timely Filing Clause
Employer Indentification Number (EIN)
Open Account
Component Billing
4. Process or tansferring account information from a journal to a ledger
Posting
Profile
Coordination of Benefits (COB)
Withhold Incentive
5. Early and Periodic Screenings - Diagnosis - and Treatment
Withhold Incentive
EPSDT
Cycle Billing
Conversion Factor
6. Checking or tracing a claim sent to an insurance comapany to determine payment or processing status
Utilization review
Peer Review Orginization (PRO)
Fiscal Intermediary (FI)
Inquiry
7. Deferred or delayed processing method for inputting data a retrieval at a later date
Batching
Component Billing
Inquiry
Customary Charge
8. Company that translates electroinc transactions between the standard formats and code set required under HIPAA and nonstandard formats and code sets
Health Care Clearinghouse
Global Period
Basic Billing and Reimbursment Steps
Assignment of Benefits
9. Request sent to an insurance comapany or other payer asking that a submitted claim be reconsidered for payment or processing
Allowed Charge
Conversion Factor
Appeal
Open Account
10. Breaking the account receivable amounts into portions for billing at a specific date of the month
Clearinghouse
Cycle Billing
Customary Charge
Open Account
11. Amount of time allowed by an insurance company for a claim to be submitted for a payment from the date of service
Exclusions and Limatations
Open Account
Timely Filing Clause
Itemized Statement
12. Federal Employees' Compensation Act
Posting
FECA
Exclusions and Limatations
Adjustment
13. 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
Life Cycle of Insurance Claims
Global Procedures
Global Procedures
14. Process of converting diagnoses - procedures - and services into numeric and alpha-numeric characters
Ranking Code
Component Billing
Coding
Unique Provider Identification Number(UPIN)
15. Federal Tax identification number - issued by internal revenue service -social security number used if employer doesn't have a EIN
Assignment of Benefits
Exclusions and Limatations
Fee Slip
Employer Indentification Number (EIN)
16. Physician has a seperate PPIN for each group/clinic in which they practices
DMERC
Coordination of Benefits (COB)
Performing Provider Identification Number(PPIN)
Unarthorized Benefit
17. Authorization by a policyholder to allow a thrid-party payer to pay benefits to a health care provider
Assignment
Component Billing
Open Account
Employer Indentification Number (EIN)
18. Record to track patients charges - payments - adjustments - and balance due
Adjustment Codes
Unit Count
Ledger Card
Component Billing
19. Process of looking over a cliam to assess payment amounts
Skip
Review
V.I. Payment
Unit Count
20. Money amount determined by dividing the actual charge of a service or procedure by a relative unit
Conversion Factor
State License Number
Encounter Form(Superbill)
Aging Accounts
21. 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
EPSDT
Electronic Claim
Health Care Clearinghouse
Cycle Billing
22. Patient who owes a balance on the account who has moved without a forwarding address
Skip
Commerical Payer
Insurance Adjustment(write off)
Aging Accounts
23. Money amount determined by dividing the actual charge of a service or procedure by a relative unit
Conversion Factor
Accepted Assignments
Collection Ratio
Claim Form is divided into 2 sections
24. Working diagnosis which is not yet est.
Truth in Lending
Performing Provider Identification Number(PPIN)
Withhold Incentive
Qualified Diagnosis
25. Durable Medical Equipment Regional Carrier
Explaination of Benefits
DMERC
Commerical Payer
Medical Necessity Edit Checks
26. Company that translates electroinc transactions between the standard formats and code set required under HIPAA and nonstandard formats and code sets
Performing Provider Identification Number(PPIN)
Coordination of Benefits (COB)
Universal Claim Form
Health Care Clearinghouse
27. Describes the service billed and includes a breakdown of how payment is determined
Explaination of Benefits
Aging Report
Correct Coding Initiative (CCI)
Commerical Payer
28. Listing of diagnosis - procedures - and charges for a patients visit
Insurance Adjustment(write off)
Encounter Form(Superbill)
Coordination of Benefits (COB)
Peer Review Orginization (PRO)
29. 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
Open Account
Basic Billing and Reimbursment Steps
Life Cycle of Insurance Claims
Clearinghouse
30. Electronic or paper-based report of payment sent by the payer to the provider
Commerical Payer
Remittance Advice(RA)
Clearinghouse
Accepted Assignments
31. Checking or tracing a claim sent to an insurance comapany to determine payment or processing status
Withhold Incentive
Collection Ratio
Inquiry
Accepted Assignments
32. Amount representing the charge most frequently used by a physician in a given periord of time
Withhold Incentive
Claim Form is divided into 2 sections
Customary Charge
Truth in Lending
33. Take what insurance pays
Civil Monetary Penalities Law (CMPL)
TWIP
Claim Form is divided into 2 sections
Adjudicate
34. Once claim is approved for payment Remittance Advice(RA) is sent to the provider and EOB is mailed to the policyholder
V.I. Payment
Ledger Card
Civil Monetary Penalities Law (CMPL)
Posting
35. 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)
Truth in Lending
EPSDT
36. Agreement between the patoent and the physician regarding monthly installments to pay a bill
Cycle Billing
Truth in Lending
Coding
Unique Provider Identification Number(UPIN)
37. Statement of a patient's account history - showing DOS - detailed chrages - payments - day insurance claims was submitted - applicable adjusments - and account balances
Unit Count
Professional Courtesy
Itemized Statement
Professional Courtesy
38. Relationship between the amount of money owed and the amount of money collected
Encounter Form(Superbill)
Collection Ratio
Fee-for-Service
Explaination of Benefits
39. Early and Periodic Screenings - Diagnosis - and Treatment
Assignment
EPSDT
Assignment of Benefits
Group Provider Number
40. Describes the service billed and includes a breakdown of how payment is determined
Correct Coding Initiative (CCI)
Fee Schedule
Allowed Charge
Explaination of Benefits
41. Percent of payment held back for a risk account in the HMO program
Assignment of Benefits
Medical Necessity Edit Checks
Remittance Advice(RA)
Withhold Incentive
42. 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
Group Provider Number
Group Provider Number
43. Amount required by an insurance company that must be taken off a patient's acoount based on actual agreements and participation
Insurance Adjustment(write off)
Actual Charge
Ranking Code
Unit Count
44. Physician must obtain this number in order to practice within a state
Bundling
Aging Accounts
State License Number
Ledger Card
45. Codes used by insurance compaines to explain actions taken on a Remittance Notice
Claim Form is divided into 2 sections
Adjustment Codes
Non-Covered Benefits
Medical Necessity
46. 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
Accepted Assignments
Timely Filing Clause
Appeal
Fee-for-Service
47. Using ICD-9 codes to hughest degree
Specificty
DMERC
Global Procedures
Civil Monetary Penalities Law (CMPL)
48. 1. Blocks 1-13=patient info 2.Blocks 14-33=physicians info
EPSDT
Employer Indentification Number (EIN)
Claim Form is divided into 2 sections
Fee Slip
49. Combing lesser services with a major service in order for one charge to include that variety of service
Encounter Form(Superbill)
Bundling
Exclusions and Limatations
Fee-for-Service
50. Using ICD-9 codes to hughest degree
Bundling
Review
Specificty
DMERC