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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. 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






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






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






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






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






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






7. Record to track patients charges - payments - adjustments - and balance due






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






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






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






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






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






13. Term for processing payment






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






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






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






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






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






19. Record to track patients charges - payments - adjustments - and balance due






20. 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'






21. Number assigned by insurance companies to a physician who renders service to patients






22. Relationship between the amount of money owed and the amount of money collected






23. 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






24. Working diagnosis which is not yet est.






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






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






27. Money amount determined by dividing the actual charge of a service or procedure by a relative unit






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






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






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






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






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






33. Relationship between the amount of money owed and the amount of money collected






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






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






36. 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






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






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






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






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






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






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






43. 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






44. 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'






45. 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`






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






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






48. Amount charged by a practice when providing services






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






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