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Test your basic knowledge |
Medical Billing Claims Basics
Start Test
Study First
Subject
:
medical-transcription
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. Passed by the federal government to prosecute cases of Medicaid fraud
Basic Billing and Reimbursment Steps
Open Account
Civil Monetary Penalities Law (CMPL)
Insurance Adjustment(write off)
2. Describes the service billed and includes a breakdown of how payment is determined
Utilization review
Coordination of Benefits (COB)
Global Procedures
Explaination of Benefits
3. Combing lesser services with a major service in order for one charge to include that variety of service
Inquiry
Bundling
Posting
EPSDT
4. Money amount determined by dividing the actual charge of a service or procedure by a relative unit
Conversion Factor
Performing Provider Identification Number(PPIN)
Inquiry
Group Practice
5. Reimbursement directly sent from payer to provider
Assignment of Benefits
Fee-for-Service
Unarthorized Benefit
Cycle Billing
6. Working diagnosis which is not yet est.
Component Billing
Performing Provider Identification Number(PPIN)
Qualified Diagnosis
Assignment
7. Process of looking over a cliam to assess payment amounts
Batching
FECA
Review
Claim Form is divided into 2 sections
8. 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
Fee-for-Service
Provider Identification Number (PIN)
Group Practice
Performing Provider Identification Number(PPIN)
9. Means to report the number of times a service was provided on the same date of service to the same patient
Unit Count
Basic Billing and Reimbursment Steps
V.I. Payment
Life Cycle of Insurance Claims
10. Agreement between the patoent and the physician regarding monthly installments to pay a bill
Skip
Ledger Card
Fee-for-Service
Truth in Lending
11. Term for processing payment
Adjudicate
Inquiry
Qualified Diagnosis
Timely Filing Clause
12. Amount of time allowed by an insurance company for a claim to be submitted for a payment from the date of service
Conversion Factor
Timely Filing Clause
Group Practice
Global Procedures
13. Conditions - situations - and services not covered by the insurance carrier
Exclusions and Limatations
Adjudicate
Paper Claims
Assignment
14. Physician must obtain this number in order to practice within a state
State License Number
Fee Slip
Conversion Factor
Open Account
15. When two companies work together to decided payment of benefits
V.I. Payment
Timely Filing Clause
Conversion Factor
Coordination of Benefits (COB)
16. List of CPT codes used by a physician with a corresponding fee that is usually calculated and maintained by a third-party payer
Aging Accounts
Medical Necessity Edit Checks
Profile
Health Care Clearinghouse
17. Once claim is approved for payment Remittance Advice(RA) is sent to the provider and EOB is mailed to the policyholder
Open Account
Collection Ratio
Suspended File Report
V.I. Payment
18. Electronic or paper-based report of payment sent by the payer to the provider
Remittance Advice(RA)
Accepted Assignments
Aging Report
Professional Courtesy
19. Federal Tax identification number - issued by internal revenue service -social security number used if employer doesn't have a EIN
Employer Indentification Number (EIN)
Electronic Claim
Adjustment Codes
Health Care Clearinghouse
20. Physician must obtain this number in order to practice within a state
Electronic Claim
State License Number
Coordination of Benefits (COB)
Fee Slip
21. Listing service in their order of importance by dates of service and values. Highest charge to lowest charge
Health Care Clearinghouse
Specificty
Ranking Code
Ledger Card
22. 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`
Group Provider Number
Paper Claims
Fee Slip
Unarthorized Benefit
23. 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
Encounter Form(Superbill)
Civil Monetary Penalities Law (CMPL)
Basic Billing and Reimbursment Steps
Inquiry
24. Patient who owes a balance on the account who has moved without a forwarding address
Skip
Posting
Component Billing
Explaination of Benefits
25. Amount representing the charge most frequently used by a physician in a given periord of time
Review
FECA
Customary Charge
Non-Covered Benefits
26. Breaking the account receivable amounts into portions for billing at a specific date of the month
Ranking Code
Appeal
Ranking Code
Cycle Billing
27. Agreement between the patoent and the physician regarding monthly installments to pay a bill
Life Cycle of Insurance Claims
Actual Charge
Truth in Lending
Accepted Assignments
28. Listing of diagnosis - procedures - and charges for a patients visit
Allowed Charge
Encounter Form(Superbill)
Exclusions and Limatations
Medical Necessity Edit Checks
29. Private health insurance company or employer-based group insurance plan that pays claims for eligible participants
Commerical Payer
Universal Claim Form
Dun/Dunning
Professional Courtesy
30. Provider agrees to accept what insurance company approves as payment in full for the claim
Commerical Payer
Fee Slip
Accepted Assignments
Performing Provider Identification Number(PPIN)
31. Durable Medical Equipment Regional Carrier
DMERC
Peer Review Orginization (PRO)
Specificty
Paper Claims
32. Combing lesser services with a major service in order for one charge to include that variety of service
Timely Filing Clause
Insurance Adjustment(write off)
Medical Necessity
Bundling
33. Codes used by insurance compaines to explain actions taken on a Remittance Notice
Specificty
Fee-for-Service
Adjustment Codes
Dun/Dunning
34. Breaking the account receivable amounts into portions for billing at a specific date of the month
DMERC
Cycle Billing
Exclusions and Limatations
Open Account
35. Request or message to remind a patient that the account is over due or delinquent
Actual Charge
Dun/Dunning
Electronic Claim
Adjustment
36. Early and Periodic Screenings - Diagnosis - and Treatment
TWIP
Group Provider Number
EPSDT
Unit Count
37. Request sent to an insurance comapany or other payer asking that a submitted claim be reconsidered for payment or processing
Accepted Assignments
Truth in Lending
Fee Schedule
Appeal
38. The amount set by the carrier for the reimbursement of services
Allowed Charge
The Patient Care Partnership(Patients Bill of Rights)
Fee-for-Service
Conversion Factor
39. Billing for each item service provided to a patient in accourdance with insurance carriers' policies
Assignment
Group Practice
Fee Slip
Component Billing
40. Amount representing the charge most frequently used by a physician in a given periord of time
Fee Schedule
Adjudicate
Customary Charge
Skip
41. Statement of a patient's account history - showing DOS - detailed chrages - payments - day insurance claims was submitted - applicable adjusments - and account balances
Itemized Statement
Bundling
Inquiry
Medical Necessity
42. 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`
Assignment of Benefits
Truth in Lending
Qualified Diagnosis
Paper Claims
43. Amount required by an insurance company that must be taken off a patient's acoount based on actual agreements and participation
Ledger Card
Qualified Diagnosis
Insurance Adjustment(write off)
Cycle Billing
44. Money amount determined by dividing the actual charge of a service or procedure by a relative unit
Suspended File Report
Conversion Factor
Peer Review Orginization (PRO)
Basic Billing and Reimbursment Steps
45. 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
Withhold Incentive
Fee-for-Service
Coding
Actual Charge
46. 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
Qualified Diagnosis
Posting
Group Provider Number
Universal Claim Form
47. Once claim is approved for payment Remittance Advice(RA) is sent to the provider and EOB is mailed to the policyholder
Customary Charge
Non-Covered Benefits
V.I. Payment
FECA
48. 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
V.I. Payment
Non-Covered Benefits
Profile
Fee Slip
49. Federal Employees' Compensation Act
Life Cycle of Insurance Claims
FECA
Posting
Unit Count
50. Authorization by a policyholder to allow a thrid-party payer to pay benefits to a health care provider
Suspended File Report
Open Account
Life Cycle of Insurance Claims
Assignment