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. Durable Medical Equipment Regional Carrier






2. Using ICD-9 codes to hughest degree






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






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






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






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






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






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






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






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






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






12. 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






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






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






15. 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






16. 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`






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






18. 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'






19. 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






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






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






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






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






24. 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






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






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






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






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






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






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






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






32. Superbill or Encounter Form






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






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






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






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






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






38. The amount set by the carrier for the reimbursement of services






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






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






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






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






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






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






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






46. 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






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






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






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






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