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






2. 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






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






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






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






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






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






8. Durable Medical Equipment Regional Carrier






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






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






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






12. Using ICD-9 codes to hughest degree






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






14. Amount charged by a practice when providing services






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






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






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






18. Reimbursement directly sent from payer to provider






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






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. 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






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






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






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






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






26. Provider agrees to accept what insurance company approves as payment in full for the claim






27. Federal Employees' Compensation Act






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






29. Patient who owes a balance on the account who has moved without a forwarding address






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






31. 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






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






33. 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






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






35. Take what insurance pays






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






37. 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






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






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






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






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






42. 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






43. 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`






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






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






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






47. Using ICD-9 codes to hughest degree






48. Statement of a patient's account history - showing DOS - detailed chrages - payments - day insurance claims was submitted - applicable adjusments - and account balances






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






50. 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