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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. Durable Medical Equipment Regional Carrier
Conversion Factor
Encounter Form(Superbill)
Customary Charge
DMERC
2. Procedure or services provided without proper authorizationor was not covered by a current authorization -denied - provider can't bill patient for charges
Aging Accounts
Claim Form is divided into 2 sections
Performing Provider Identification Number(PPIN)
Unarthorized Benefit
3. Assigned to the physician by Medicare program
DMERC
Unique Provider Identification Number(UPIN)
Group Practice
Exclusions and Limatations
4. Electronic or paper-based report of payment sent by the payer to the provider
Insurance Adjustment(write off)
Non-Covered Benefits
Remittance Advice(RA)
Batching
5. 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
Basic Billing and Reimbursment Steps
Truth in Lending
Civil Monetary Penalities Law (CMPL)
Peer Review Orginization (PRO)
6. CMS 1500 - became effective July 2007 -All third party payers accept it - Medicare requires all physicians to use it
Universal Claim Form
Global Procedures
Utilization review
Adjustment
7. Agreement between the patoent and the physician regarding monthly installments to pay a bill
State License Number
V.I. Payment
Truth in Lending
Timely Filing Clause
8. Request or message to remind a patient that the account is over due or delinquent
Fee-for-Service
Dun/Dunning
Collection Ratio
Unit Count
9. Durable Medical Equipment Regional Carrier
Basic Billing and Reimbursment Steps
Insurance Adjustment(write off)
Clearinghouse
DMERC
10. 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
Assignment
Employer Indentification Number (EIN)
Ledger Card
11. Passed by the federal government to prosecute cases of Medicaid fraud
Posting
Fee Schedule
Civil Monetary Penalities Law (CMPL)
Accepted Assignments
12. 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
Commerical Payer
Adjustment
Profile
Universal Claim Form
13. 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
Skip
Provider Identification Number (PIN)
Specificty
Medical Necessity Edit Checks
14. A report to track claim status of patient accounts and to identify individual accounts requiring additional workup for payments or write-offs
Employer Indentification Number (EIN)
Group Provider Number
Itemized Statement
Aging Report
15. 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
Performing Provider Identification Number(PPIN)
Basic Billing and Reimbursment Steps
Encounter Form(Superbill)
Commerical Payer
16. Reimbursement directly sent from payer to provider
Assignment of Benefits
Allowed Charge
Component Billing
Group Practice
17. Process of assesing medical services to assure medical necessity and the appropriateness of treatment
Suspended File Report
Utilization review
Peer Review Orginization (PRO)
Accepted Assignments
18. Physician has a seperate PPIN for each group/clinic in which they practices
FECA
Aging Report
Unique Provider Identification Number(UPIN)
Performing Provider Identification Number(PPIN)
19. Physician must obtain this number in order to practice within a state
Electronic Claim
State License Number
Inquiry
FECA
20. Promote interest and well being of the patients and residents of healthcare facility
Fiscal Intermediary (FI)
The Patient Care Partnership(Patients Bill of Rights)
Performing Provider Identification Number(PPIN)
Provider Identification Number (PIN)
21. When two companies work together to decided payment of benefits
Aging Report
Coordination of Benefits (COB)
Adjudicate
Assignment
22. Request or message to remind a patient that the account is over due or delinquent
Paper Claims
Skip
Life Cycle of Insurance Claims
Dun/Dunning
23. Company that translates electroinc transactions between the standard formats and code set required under HIPAA and nonstandard formats and code sets
Aging Report
Health Care Clearinghouse
Professional Courtesy
V.I. Payment
24. Process of assesing medical services to assure medical necessity and the appropriateness of treatment
Coordination of Benefits (COB)
Utilization review
Explaination of Benefits
State License Number
25. 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
Truth in Lending
Commerical Payer
FECA
Life Cycle of Insurance Claims
26. Process of converting diagnoses - procedures - and services into numeric and alpha-numeric characters
EPSDT
Group Practice
Unit Count
Coding
27. Bundling edits by CMS to combine various component items with a major service or procedure
Adjustment
Bundling
Provider Identification Number (PIN)
Correct Coding Initiative (CCI)
28. Superbill or Encounter Form
Utilization review
Fee Slip
Ranking Code
Paper Claims
29. Record to track patients charges - payments - adjustments - and balance due
Fiscal Intermediary (FI)
Ledger Card
V.I. Payment
Dun/Dunning
30. Process of converting diagnoses - procedures - and services into numeric and alpha-numeric characters
Dun/Dunning
Coding
Utilization review
Appeal
31. 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'
Customary Charge
Bundling
Commerical Payer
Medical Necessity
32. Percent of payment held back for a risk account in the HMO program
DMERC
Ranking Code
Withhold Incentive
Assignment of Benefits
33. Federal Tax identification number - issued by internal revenue service -social security number used if employer doesn't have a EIN
Non-Covered Benefits
Employer Indentification Number (EIN)
Customary Charge
Coordination of Benefits (COB)
34. Record to track patients charges - payments - adjustments - and balance due
Basic Billing and Reimbursment Steps
Utilization review
Coding
Ledger Card
35. Amount required by an insurance company that must be taken off a patient's acoount based on actual agreements and participation
Claim Form is divided into 2 sections
Insurance Adjustment(write off)
DMERC
EPSDT
36. Insurance company that bids for a contract with CMS to handle the Medicare program in a specific area
Fiscal Intermediary (FI)
Accepted Assignments
Fee Schedule
FECA
37. Analysis of accounts receivable that indicate delinquency of 60 - 90 - 120 days
Ledger Card
Profile
Aging Accounts
Adjudicate
38. Bundling edits by CMS to combine various component items with a major service or procedure
Group Provider Number
Correct Coding Initiative (CCI)
Review
State License Number
39. 1. Blocks 1-13=patient info 2.Blocks 14-33=physicians info
Correct Coding Initiative (CCI)
Provider Identification Number (PIN)
Claim Form is divided into 2 sections
Fee Slip
40. Private health insurance company or employer-based group insurance plan that pays claims for eligible participants
Assignment
Assignment of Benefits
Withhold Incentive
Commerical Payer
41. Working diagnosis which is not yet est.
State License Number
Aging Accounts
Qualified Diagnosis
Collection Ratio
42. CMS 1500 - became effective July 2007 -All third party payers accept it - Medicare requires all physicians to use it
State License Number
Inquiry
Aging Report
Universal Claim Form
43. Process of looking over a cliam to assess payment amounts
Appeal
Ranking Code
Review
Non-Covered Benefits
44. Company that translates electroinc transactions between the standard formats and code set required under HIPAA and nonstandard formats and code sets
Encounter Form(Superbill)
The Patient Care Partnership(Patients Bill of Rights)
Health Care Clearinghouse
Assignment
45. Electronic or paper-based report of payment sent by the payer to the provider
Employer Indentification Number (EIN)
Timely Filing Clause
Professional Courtesy
Remittance Advice(RA)
46. Patient who owes a balance on the account who has moved without a forwarding address
Truth in Lending
Skip
EPSDT
Component Billing
47. Listing service in their order of importance by dates of service and values. Highest charge to lowest charge
Specificty
Fee Schedule
Ranking Code
Timely Filing Clause
48. Listing of claims that have incorrect information such as posting error or missing information to process a claim
Life Cycle of Insurance Claims
Suspended File Report
Accepted Assignments
Global Procedures
49. 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
V.I. Payment
Ranking Code
Batching
Non-Covered Benefits
50. 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
Ledger Card
Fee-for-Service
Ranking Code
Batching