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






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






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






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






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






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






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






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






9. Take what insurance pays






10. 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






11. 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






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






13. Term for processing payment






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






15. 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






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






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






18. Take what insurance pays






19. Reimbursement directly sent from payer to provider






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






21. Defined by Medicare as 'The determination that a service or procedure rendered is resonable and necessary for the diagnosis or treatment of an illness or injury'






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






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






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






25. 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






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






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






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






29. Defined by Medicare as 'The determination that a service or procedure rendered is resonable and necessary for the diagnosis or treatment of an illness or injury'






30. 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






31. Assigned to the physician by Medicare program






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






33. Superbill or Encounter Form






34. Reimbursement directly sent from payer to provider






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






36. 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






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






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






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






40. Federal Employees' Compensation Act






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






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






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






44. 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






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






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






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






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






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






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