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






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






4. Working diagnosis which is not yet est.






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






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






7. 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






8. Amount charged by a practice when providing services






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






10. 1. Blocks 1-13=patient info 2.Blocks 14-33=physicians info






11. Durable Medical Equipment Regional Carrier






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






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






14. Reimbursement directly sent from payer to provider






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






16. Amount charged by a practice when providing services






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






18. 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






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






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






21. 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






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






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






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






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






26. Means to report the number of times a service was provided on the same date of service to the same patient






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






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






29. Using ICD-9 codes to hughest degree






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






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






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






33. Assigned to the physician by Medicare program






34. Using ICD-9 codes to hughest degree






35. Working diagnosis which is not yet est.






36. 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'






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






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






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






40. Private health insurance company or employer-based group insurance plan that pays claims for eligible participants






41. 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






42. 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






43. 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






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






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






46. Take what insurance pays






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






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






49. 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`






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