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






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






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






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






5. Amount charged by a practice when providing services






6. 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`






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






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






9. Early and Periodic Screenings - Diagnosis - and Treatment






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






11. 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






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






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






14. 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






15. 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'






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






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






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






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






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






22. Term for processing payment






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






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






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






26. 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






27. Assigned to the physician by Medicare program






28. 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






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






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






31. 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






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






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






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






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






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






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






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






39. Amount charged by a practice when providing services






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






41. Superbill or Encounter Form






42. Early and Periodic Screenings - Diagnosis - and Treatment






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






44. Reimbursement directly sent from payer to provider






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






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






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






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






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






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