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






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






3. Amount charged by a practice when providing services






4. Term for processing payment






5. Take what insurance pays






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






7. 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






8. Take what insurance pays






9. Amount required by an insurance company that must be taken off a patient's acoount based on actual agreements and participation






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






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






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






13. 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






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






15. 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






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






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






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






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






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






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






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






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






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






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






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






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






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






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






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






31. 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






32. 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






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






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






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






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






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






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






39. 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`






40. Assigned to the physician by Medicare program






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






42. Durable Medical Equipment Regional Carrier






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






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






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






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






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






48. Relationship between the amount of money owed and the amount of money collected






49. Durable Medical Equipment Regional Carrier






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