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






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






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






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






5. 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






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






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






8. Term for processing payment






9. Reimbursement directly sent from payer to provider






10. Statement of a patient's account history - showing DOS - detailed chrages - payments - day insurance claims was submitted - applicable adjusments - and account balances






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






12. 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






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






14. Amount charged by a practice when providing services






15. 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






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






17. Durable Medical Equipment Regional Carrier






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






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






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






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






22. 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






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






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






25. 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






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






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






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






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






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






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






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






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






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






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






36. 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






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






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






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






40. Company that translates electroinc transactions between the standard formats and code set required under HIPAA and nonstandard formats and code sets






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






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






43. 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






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






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






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






47. 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






48. Working diagnosis which is not yet est.






49. Company that translates electroinc transactions between the standard formats and code set required under HIPAA and nonstandard formats and code sets






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