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. 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






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






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






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






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






6. 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






7. Assigned to the physician by Medicare program






8. 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






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






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






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






12. Amount charged by a practice when providing services






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






14. Insurance company that bids for a contract with CMS to handle the Medicare program in a specific area






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






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






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






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






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






20. 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






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






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






23. 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'






24. Early and Periodic Screenings - Diagnosis - and Treatment






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






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






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






28. Superbill or Encounter Form






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






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






31. 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






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






33. 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






34. 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`






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






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






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






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






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






40. 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






41. Specific time frames assigned to a code by an insurance comapny before additional payment will be made following a surgical procedure






42. Assigned to the physician by Medicare program






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






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






45. Amount of time allowed by an insurance company for a claim to be submitted for a payment from the date of service






46. Take what insurance pays






47. Amount required by an insurance company that must be taken off a patient's acoount based on actual agreements and participation






48. 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






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






50. Specific time frames assigned to a code by an insurance comapny before additional payment will be made following a surgical procedure