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. Process of looking over a cliam to assess payment amounts






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






3. 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






4. 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






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






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






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






8. Amount charged by a practice when providing services






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






10. 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






11. Term for processing payment






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






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






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






15. 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






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






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






18. Using ICD-9 codes to hughest degree






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






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






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






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






23. 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






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






25. Working diagnosis which is not yet est.






26. Term for processing payment






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






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






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






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






31. 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`






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






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






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






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






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






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






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






40. 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






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






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






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






44. 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






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






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






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






48. 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






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






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