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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. 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






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






3. Take what insurance pays






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






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






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






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






8. 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`






9. 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






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






11. 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






12. Reimbursement directly sent from payer to provider






13. Federal Employees' Compensation Act






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






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






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






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






18. 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






19. Assigned to the physician by Medicare program






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






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






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






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






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






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






26. Term for processing payment






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






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






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






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






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






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






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






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






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






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






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






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






39. Early and Periodic Screenings - Diagnosis - and Treatment






40. Term for processing payment






41. Using ICD-9 codes to hughest degree






42. Early and Periodic Screenings - Diagnosis - and Treatment






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






44. Reimbursement directly sent from payer to provider






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






46. Take what insurance pays






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






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






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






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







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