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






2. Using ICD-9 codes to hughest degree






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






4. 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






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






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






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






8. Reimbursement directly sent from payer to provider






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






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






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






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






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






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






15. Assigned to the physician by Medicare program






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






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






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






19. Federal Employees' Compensation Act






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






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






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






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






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






25. Amount charged by a practice when providing services






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






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






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






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






30. 1. Blocks 1-13=patient info 2.Blocks 14-33=physicians info






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






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






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






34. 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






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






36. Accounts that are subject to charges from time to time






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






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






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






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






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






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






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






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






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






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






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






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






49. Reimbursement directly sent from payer to provider






50. 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