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. When two companies work together to decided payment of benefits






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






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






4. Once claim is approved for payment Remittance Advice(RA) is sent to the provider and EOB is mailed to the policyholder






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






6. 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






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






8. Working diagnosis which is not yet est.






9. A report to track claim status of patient accounts and to identify individual accounts requiring additional workup for payments or write-offs






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






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






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






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






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






16. 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






17. Amount charged by a practice when providing services






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






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






20. Take what insurance pays






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






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






23. 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`






24. 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






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






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






27. 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'






28. Reimbursement directly sent from payer to provider






29. 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






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






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






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






33. List of CPT codes used by a physician with a corresponding fee that is usually calculated and maintained by a third-party payer






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






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






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






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






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






39. Request or message to remind a patient that the account is over due or delinquent






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






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






43. Checking or tracing a claim sent to an insurance comapany to determine payment or processing status






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






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






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






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






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






49. Listing of diagnosis - procedures - and charges for a patients visit






50. Superbill or Encounter Form