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






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






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






4. 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`






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






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






7. 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`






8. Early and Periodic Screenings - Diagnosis - and Treatment






9. Take what insurance pays






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






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






13. Term for processing payment






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






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






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






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






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






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






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






21. 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






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






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






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






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






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






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






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






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






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






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






32. Durable Medical Equipment Regional Carrier






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






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






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






36. 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






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






38. Bundling edits by CMS to combine various component items with a major service or procedure






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






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






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






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






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






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






45. 1. Blocks 1-13=patient info 2.Blocks 14-33=physicians info






46. Superbill or Encounter Form






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






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






49. Federal Employees' Compensation Act






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