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






3. Working diagnosis which is not yet est.






4. Durable Medical Equipment Regional Carrier






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






6. 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






7. 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






8. 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






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






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






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






12. 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






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






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






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






17. Superbill or Encounter Form






18. 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






19. 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`






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






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






22. Superbill or Encounter Form






23. 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






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






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






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






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






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






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






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






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






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






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






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






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






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






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






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






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






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






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






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






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






45. Term for processing payment






46. Amount representing the charge most frequently used by a physician in a given periord of time






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






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






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






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