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






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






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






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






6. 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






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






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






9. Using ICD-9 codes to hughest degree






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






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






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






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






14. Take what insurance pays






15. 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






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






17. Amount charged by a practice when providing services






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






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






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






21. Assigned to the physician by Medicare program






22. 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






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






24. 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






25. Working diagnosis which is not yet est.






26. 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'






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






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






29. Term for processing payment






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






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






33. Superbill or Encounter Form






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






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






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






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






38. Term for processing payment






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






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






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






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






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






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






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






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






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






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






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






50. Take what insurance pays