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. Patient who owes a balance on the account who has moved without a forwarding address






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






3. A report to track claim status of patient accounts and to identify individual accounts requiring additional workup for payments or write-offs






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






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






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






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






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






9. 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






10. 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






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






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






13. 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






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






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






16. Term for processing payment






17. Working diagnosis which is not yet est.






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






19. 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






20. Term for processing payment






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






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






23. Superbill or Encounter Form






24. Early and Periodic Screenings - Diagnosis - and Treatment






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






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






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






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






29. Amount charged by a practice when providing services






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






31. 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






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






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






34. Assigned to the physician by Medicare program






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






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






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






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






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






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






41. 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






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






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






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






45. 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






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






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






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






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






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