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






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






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






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






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






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






7. Amount charged by a practice when providing services






8. 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






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






10. 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






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






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






13. 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






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






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






16. 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






17. Federal Employees' Compensation Act






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






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






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






21. 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






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






23. When two companies work together to decided payment of benefits






24. Term for processing payment






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






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






27. 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






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






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






30. Assigned to the physician by Medicare program






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






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






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






34. Federal Employees' Compensation Act






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






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






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






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






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






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






41. Working diagnosis which is not yet est.






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






43. Early and Periodic Screenings - Diagnosis - and Treatment






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






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






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






47. Take what insurance pays






48. 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'






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






50. Term for processing payment