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. Superbill or Encounter Form






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






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






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






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






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






7. Using ICD-9 codes to hughest degree






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






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






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






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






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






13. Durable Medical Equipment Regional Carrier






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






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






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






17. Early and Periodic Screenings - Diagnosis - and Treatment






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






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






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






21. Assigned to the physician by Medicare program






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






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






24. 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






25. 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






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






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






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






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






30. 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






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






32. 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






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






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






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






36. Record to track patients charges - payments - adjustments - and balance due






37. Federal Employees' Compensation Act






38. Early and Periodic Screenings - Diagnosis - and Treatment






39. 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`






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






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






42. 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






43. Durable Medical Equipment Regional Carrier






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






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






46. 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






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






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






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






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