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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. Federal Tax identification number - issued by internal revenue service -social security number used if employer doesn't have a EIN
Adjustment
Group Practice
Exclusions and Limatations
Employer Indentification Number (EIN)
2. 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
Group Provider Number
Medical Necessity
Aging Report
Utilization review
3. List of CPT codes used by a physician with a corresponding fee that is usually calculated and maintained by a third-party payer
Fee Schedule
Profile
Ranking Code
Group Provider Number
4. CMS 1500 - became effective July 2007 -All third party payers accept it - Medicare requires all physicians to use it
Encounter Form(Superbill)
Cycle Billing
Universal Claim Form
Commerical Payer
5. The amount set by the carrier for the reimbursement of services
Peer Review Orginization (PRO)
Allowed Charge
Professional Courtesy
State License Number
6. Passed by the federal government to prosecute cases of Medicaid fraud
State License Number
Civil Monetary Penalities Law (CMPL)
Ledger Card
Conversion Factor
7. Percent of payment held back for a risk account in the HMO program
Posting
Professional Courtesy
Withhold Incentive
Health Care Clearinghouse
8. Durable Medical Equipment Regional Carrier
Dun/Dunning
Accepted Assignments
Ranking Code
DMERC
9. Amount of time allowed by an insurance company for a claim to be submitted for a payment from the date of service
Correct Coding Initiative (CCI)
Unique Provider Identification Number(UPIN)
Timely Filing Clause
Basic Billing and Reimbursment Steps
10. Electronic or paper-based report of payment sent by the payer to the provider
Remittance Advice(RA)
Ledger Card
Insurance Adjustment(write off)
EPSDT
11. Combing lesser services with a major service in order for one charge to include that variety of service
Fee-for-Service
Bundling
Assignment
Basic Billing and Reimbursment Steps
12. Using ICD-9 codes to hughest degree
Allowed Charge
Unit Count
Suspended File Report
Specificty
13. Listing service in their order of importance by dates of service and values. Highest charge to lowest charge
EPSDT
Ranking Code
Dun/Dunning
Provider Identification Number (PIN)
14. Amount charged by a practice when providing services
State License Number
Truth in Lending
Actual Charge
Group Practice
15. Electronic or paper-based report of payment sent by the payer to the provider
Coding
Remittance Advice(RA)
Fiscal Intermediary (FI)
Customary Charge
16. Record to track patients charges - payments - adjustments - and balance due
Ledger Card
Coding
Clearinghouse
Universal Claim Form
17. Request sent to an insurance comapany or other payer asking that a submitted claim be reconsidered for payment or processing
Appeal
Specificty
Electronic Claim
Employer Indentification Number (EIN)
18. Reimbursement directly sent from payer to provider
Profile
Accepted Assignments
Ranking Code
Assignment of Benefits
19. Accounts that are subject to charges from time to time
Health Care Clearinghouse
Unique Provider Identification Number(UPIN)
Open Account
Actual Charge
20. 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
Group Practice
Performing Provider Identification Number(PPIN)
Adjudicate
Assignment
21. 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
Global Procedures
Group Practice
Medical Necessity
Encounter Form(Superbill)
22. Codes used by insurance compaines to explain actions taken on a Remittance Notice
Claim Form is divided into 2 sections
Open Account
Electronic Claim
Adjustment Codes
23. A report to track claim status of patient accounts and to identify individual accounts requiring additional workup for payments or write-offs
Specificty
Aging Report
Medical Necessity
The Patient Care Partnership(Patients Bill of Rights)
24. Major surgical procedures that typically have a follow-up period of 30 - 60 - 90 - 120 days
Global Procedures
Adjudicate
Withhold Incentive
TWIP
25. Authorization by a policyholder to allow a thrid-party payer to pay benefits to a health care provider
Coordination of Benefits (COB)
Allowed Charge
Provider Identification Number (PIN)
Assignment
26. Provider agrees to accept what insurance company approves as payment in full for the claim
Accepted Assignments
Non-Covered Benefits
Itemized Statement
EPSDT
27. Federal Employees' Compensation Act
FECA
Ranking Code
Itemized Statement
Group Practice
28. Procedure or services provided without proper authorizationor was not covered by a current authorization -denied - provider can't bill patient for charges
Unarthorized Benefit
Unique Provider Identification Number(UPIN)
TWIP
Conversion Factor
29. Patient who owes a balance on the account who has moved without a forwarding address
Ranking Code
Utilization review
State License Number
Skip
30. Number assigned by insurance companies to a physician who renders service to patients
Ledger Card
Inquiry
Cycle Billing
Provider Identification Number (PIN)
31. 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
Suspended File Report
Medical Necessity Edit Checks
Basic Billing and Reimbursment Steps
Fee-for-Service
32. Discount or fee exception given to a patient at the discretion of the physician
Suspended File Report
Assignment of Benefits
Clearinghouse
Professional Courtesy
33. 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
Clearinghouse
Dun/Dunning
Accepted Assignments
Cycle Billing
34. Request or message to remind a patient that the account is over due or delinquent
Life Cycle of Insurance Claims
Dun/Dunning
Bundling
Group Provider Number
35. Take what insurance pays
Fiscal Intermediary (FI)
TWIP
Life Cycle of Insurance Claims
Universal Claim Form
36. Listing of claims that have incorrect information such as posting error or missing information to process a claim
Professional Courtesy
Batching
Skip
Suspended File Report
37. 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
Aging Report
Fee-for-Service
The Patient Care Partnership(Patients Bill of Rights)
Encounter Form(Superbill)
38. Physician must obtain this number in order to practice within a state
Global Procedures
Clearinghouse
Civil Monetary Penalities Law (CMPL)
State License Number
39. Process of converting diagnoses - procedures - and services into numeric and alpha-numeric characters
Electronic Claim
Adjustment
Timely Filing Clause
Coding
40. Specific time frames assigned to a code by an insurance comapny before additional payment will be made following a surgical procedure
Group Practice
Clearinghouse
Medical Necessity
Global Period
41. The amount set by the carrier for the reimbursement of services
Accepted Assignments
Allowed Charge
Utilization review
The Patient Care Partnership(Patients Bill of Rights)
42. 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
Fiscal Intermediary (FI)
Group Practice
Non-Covered Benefits
Unit Count
43. 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`
Paper Claims
Clearinghouse
Non-Covered Benefits
Appeal
44. Combing lesser services with a major service in order for one charge to include that variety of service
Non-Covered Benefits
Bundling
Adjustment Codes
Civil Monetary Penalities Law (CMPL)
45. Promote interest and well being of the patients and residents of healthcare facility
The Patient Care Partnership(Patients Bill of Rights)
Skip
Adjustment Codes
Timely Filing Clause
46. Physician has a seperate PPIN for each group/clinic in which they practices
Inquiry
Performing Provider Identification Number(PPIN)
Global Procedures
Conversion Factor
47. Using ICD-9 codes to hughest degree
Fee-for-Service
Qualified Diagnosis
Provider Identification Number (PIN)
Specificty
48. Statement of a patient's account history - showing DOS - detailed chrages - payments - day insurance claims was submitted - applicable adjusments - and account balances
Suspended File Report
Itemized Statement
Withhold Incentive
Adjustment Codes
49. Bundling edits by CMS to combine various component items with a major service or procedure
The Patient Care Partnership(Patients Bill of Rights)
Paper Claims
Correct Coding Initiative (CCI)
Universal Claim Form
50. 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
Electronic Claim
Skip
Commerical Payer
Life Cycle of Insurance Claims