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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. 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






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






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






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






5. Superbill or Encounter Form






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






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






8. Amount charged by a practice when providing services






9. 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






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






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






12. Process of assesing medical services to assure medical necessity and the appropriateness of treatment






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






14. Assigned to the physician by Medicare program






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






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






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






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






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






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






21. Reimbursement directly sent from payer to provider






22. Working diagnosis which is not yet est.






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






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






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






26. 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






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






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






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






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






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. 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






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






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






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






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






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






38. Listing of claims that have incorrect information such as posting error or missing information to process a claim






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






40. 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






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






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






43. 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






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






45. Durable Medical Equipment Regional Carrier






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






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






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






49. Term for processing payment






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







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