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. Reimbursement directly sent from payer to provider






2. 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






3. 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






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






5. Deferred or delayed processing method for inputting data a retrieval at a later date






6. 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






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






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






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






10. Take what insurance pays






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






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






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






14. Amount charged by a practice when providing services






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






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






17. 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






18. Federal Employees' Compensation Act






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






20. Using ICD-9 codes to hughest degree






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






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






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






24. Federal Employees' Compensation Act






25. 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






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






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






28. Amount charged by a practice when providing services






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






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






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






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






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






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






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






36. 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






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






38. Durable Medical Equipment Regional Carrier






39. 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






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






41. Term for processing payment






42. Using ICD-9 codes to hughest degree






43. Superbill or Encounter Form






44. Request sent to an insurance comapany or other payer asking that a submitted claim be reconsidered for payment or processing






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






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






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






48. 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






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






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