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






2. 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`






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






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






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






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






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






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






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






10. 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






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






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






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






14. 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






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






16. 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






17. Take what insurance pays






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






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






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






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






22. Superbill or Encounter Form






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






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






25. Assigned to the physician by Medicare program






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






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






28. 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'






29. 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`






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






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






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






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






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






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






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






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






38. 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






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






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






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






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






43. 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






44. 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






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






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






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






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






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






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