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 converting diagnoses - procedures - and services into numeric and alpha-numeric characters






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






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






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






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






6. 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






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






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






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






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






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






12. Using ICD-9 codes to hughest degree






13. Durable Medical Equipment Regional Carrier






14. Amount charged by a practice when providing services






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






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






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






18. 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






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






20. 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






21. 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






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






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






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






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






26. Amount of time allowed by an insurance company for a claim to be submitted for a payment from the date of service






27. Physician must obtain this number in order to practice within a state






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






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






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






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






32. Assigned to the physician by Medicare program






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






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






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






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






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






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






39. Working diagnosis which is not yet est.






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






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






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






43. Amount charged by a practice when providing services






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






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






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






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






48. 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






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






50. 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