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






2. Reimbursement directly sent from payer to provider






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






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






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






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






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






8. 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






9. Early and Periodic Screenings - Diagnosis - and Treatment






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






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






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






13. 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






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






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






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






17. 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






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






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






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






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






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






23. Superbill or Encounter Form






24. Assigned to the physician by Medicare program






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






26. 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






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






28. Superbill or Encounter Form






29. 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'






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






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






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






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






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






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






36. 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






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






38. Process of looking over a cliam to assess payment amounts






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






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






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






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






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






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






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






46. Term for processing payment






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






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






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






50. Early and Periodic Screenings - Diagnosis - and Treatment







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