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Test your basic knowledge |
Medical Billing Claims Basics
Start Test
Study First
Subject
:
medical-transcription
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. Billing for each item service provided to a patient in accourdance with insurance carriers' policies
Professional Courtesy
Explaination of Benefits
Open Account
Component Billing
2. Major surgical procedures that typically have a follow-up period of 30 - 60 - 90 - 120 days
Profile
Global Procedures
Qualified Diagnosis
Medical Necessity Edit Checks
3. Procedure or services provided without proper authorizationor was not covered by a current authorization -denied - provider can't bill patient for charges
Allowed Charge
Fee Schedule
Unarthorized Benefit
Customary Charge
4. Take what insurance pays
Insurance Adjustment(write off)
Cycle Billing
TWIP
Aging Accounts
5. Amount of time allowed by an insurance company for a claim to be submitted for a payment from the date of service
Global Procedures
Explaination of Benefits
Assignment
Timely Filing Clause
6. Amount charged by a practice when providing services
Claim Form is divided into 2 sections
Posting
Global Period
Actual Charge
7. Listing of claims that have incorrect information such as posting error or missing information to process a claim
Suspended File Report
Correct Coding Initiative (CCI)
The Patient Care Partnership(Patients Bill of Rights)
Withhold Incentive
8. CMS 1500 - became effective July 2007 -All third party payers accept it - Medicare requires all physicians to use it
Health Care Clearinghouse
Correct Coding Initiative (CCI)
Universal Claim Form
Cycle Billing
9. Listing service in their order of importance by dates of service and values. Highest charge to lowest charge
Universal Claim Form
Aging Accounts
Withhold Incentive
Ranking Code
10. Deferred or delayed processing method for inputting data a retrieval at a later date
Accepted Assignments
Electronic Claim
Group Provider Number
Batching
11. Physician must obtain this number in order to practice within a state
Adjudicate
Open Account
State License Number
Accepted Assignments
12. A report to track claim status of patient accounts and to identify individual accounts requiring additional workup for payments or write-offs
Profile
Aging Report
Explaination of Benefits
Adjustment
13. List of CPT codes used by a physician with a corresponding fee that is usually calculated and maintained by a third-party payer
Exclusions and Limatations
Profile
Withhold Incentive
Collection Ratio
14. Established proce set by a medical practice for proefessional services
Fee Schedule
Bundling
Allowed Charge
Skip
15. Request or message to remind a patient that the account is over due or delinquent
Ledger Card
Aging Report
Dun/Dunning
Assignment of Benefits
16. Specific time frames assigned to a code by an insurance comapny before additional payment will be made following a surgical procedure
Itemized Statement
Global Period
Allowed Charge
Explaination of Benefits
17. Breaking the account receivable amounts into portions for billing at a specific date of the month
Cycle Billing
Ranking Code
Employer Indentification Number (EIN)
Unarthorized Benefit
18. 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
Non-Covered Benefits
Professional Courtesy
Cycle Billing
Appeal
19. Working diagnosis which is not yet est.
Insurance Adjustment(write off)
Global Period
Qualified Diagnosis
Clearinghouse
20. Request sent to an insurance comapany or other payer asking that a submitted claim be reconsidered for payment or processing
Peer Review Orginization (PRO)
Appeal
The Patient Care Partnership(Patients Bill of Rights)
Paper Claims
21. Physician has a seperate PPIN for each group/clinic in which they practices
Provider Identification Number (PIN)
Truth in Lending
Performing Provider Identification Number(PPIN)
The Patient Care Partnership(Patients Bill of Rights)
22. 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
The Patient Care Partnership(Patients Bill of Rights)
FECA
Group Provider Number
Qualified Diagnosis
23. Percent of payment held back for a risk account in the HMO program
Cycle Billing
Ledger Card
Employer Indentification Number (EIN)
Withhold Incentive
24. Provider agrees to accept what insurance company approves as payment in full for the claim
Professional Courtesy
Accepted Assignments
Electronic Claim
Appeal
25. 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
Fee-for-Service
Ledger Card
Non-Covered Benefits
Clearinghouse
26. Agreement between the patoent and the physician regarding monthly installments to pay a bill
Truth in Lending
State License Number
V.I. Payment
Life Cycle of Insurance Claims
27. Bundling edits by CMS to combine various component items with a major service or procedure
Clearinghouse
Coding
Correct Coding Initiative (CCI)
Universal Claim Form
28. 1. Blocks 1-13=patient info 2.Blocks 14-33=physicians info
Truth in Lending
Allowed Charge
Component Billing
Claim Form is divided into 2 sections
29. Checking or tracing a claim sent to an insurance comapany to determine payment or processing status
Customary Charge
Inquiry
Medical Necessity Edit Checks
Ledger Card
30. The amount set by the carrier for the reimbursement of services
Civil Monetary Penalities Law (CMPL)
Suspended File Report
Allowed Charge
Fee Schedule
31. A report to track claim status of patient accounts and to identify individual accounts requiring additional workup for payments or write-offs
Appeal
Aging Report
Medical Necessity
Dun/Dunning
32. Record to track patients charges - payments - adjustments - and balance due
Non-Covered Benefits
Ledger Card
Insurance Adjustment(write off)
Assignment
33. Procedure or services provided without proper authorizationor was not covered by a current authorization -denied - provider can't bill patient for charges
Clearinghouse
Explaination of Benefits
EPSDT
Unarthorized Benefit
34. Money amount determined by dividing the actual charge of a service or procedure by a relative unit
Universal Claim Form
Conversion Factor
Unique Provider Identification Number(UPIN)
Inquiry
35. Term for processing payment
Adjudicate
Medical Necessity
Open Account
Fee Slip
36. Using ICD-9 codes to hughest degree
Life Cycle of Insurance Claims
Specificty
Qualified Diagnosis
Allowed Charge
37. 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
Basic Billing and Reimbursment Steps
Employer Indentification Number (EIN)
Life Cycle of Insurance Claims
Suspended File Report
38. 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`
Paper Claims
Correct Coding Initiative (CCI)
Utilization review
Specificty
39. Checking or tracing a claim sent to an insurance comapany to determine payment or processing status
Inquiry
Aging Accounts
Collection Ratio
Specificty
40. Codes used by insurance compaines to explain actions taken on a Remittance Notice
Adjustment
Withhold Incentive
Aging Accounts
Adjustment Codes
41. List of CPT codes used by a physician with a corresponding fee that is usually calculated and maintained by a third-party payer
Profile
Non-Covered Benefits
Life Cycle of Insurance Claims
State License Number
42. Private health insurance company or employer-based group insurance plan that pays claims for eligible participants
Commerical Payer
State License Number
Adjustment
Posting
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
Global Period
Fee-for-Service
FECA
Fee Slip
44. Private health insurance company or employer-based group insurance plan that pays claims for eligible participants
Commerical Payer
Unique Provider Identification Number(UPIN)
Coding
Aging Accounts
45. Insurance company that bids for a contract with CMS to handle the Medicare program in a specific area
Adjustment
Withhold Incentive
Posting
Fiscal Intermediary (FI)
46. Early and Periodic Screenings - Diagnosis - and Treatment
Qualified Diagnosis
EPSDT
Provider Identification Number (PIN)
Peer Review Orginization (PRO)
47. Patient who owes a balance on the account who has moved without a forwarding address
Batching
Assignment
Skip
Appeal
48. Listing service in their order of importance by dates of service and values. Highest charge to lowest charge
Life Cycle of Insurance Claims
Medical Necessity
Ranking Code
Review
49. Once claim is approved for payment Remittance Advice(RA) is sent to the provider and EOB is mailed to the policyholder
V.I. Payment
Suspended File Report
Fee-for-Service
Accepted Assignments
50. Federal Employees' Compensation Act
FECA
TWIP
Non-Covered Benefits
Utilization review