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. When two companies work together to decided payment of benefits






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






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






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






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






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






7. Established proce set by a medical practice for proefessional services






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






9. 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






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






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






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






13. Early and Periodic Screenings - Diagnosis - and Treatment






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






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






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. 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






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






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






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






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






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






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






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






25. Codes used by insurance compaines to explain actions taken on a Remittance Notice






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






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






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






29. Assigned to the physician by Medicare program






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






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






32. Amount required by an insurance company that must be taken off a patient's acoount based on actual agreements and participation






33. Amount charged by a practice when providing services






34. 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






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






36. 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






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






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






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






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






41. 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'






42. Durable Medical Equipment Regional Carrier






43. Federal Employees' Compensation Act






44. Take what insurance pays






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






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






47. Amount required by an insurance company that must be taken off a patient's acoount based on actual agreements and participation






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. 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






50. Term for processing payment