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. 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






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






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






4. Federal Employees' Compensation Act






5. Superbill or Encounter Form






6. 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






7. State based group of physicians working under government guideline to review cases and determine their appropriateness and quality of professional care






8. Take what insurance pays






9. 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






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






11. Early and Periodic Screenings - Diagnosis - and Treatment






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






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






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






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






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






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






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






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






20. Amount charged by a practice when providing services






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






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






23. 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






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






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






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






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






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






29. State based group of physicians working under government guideline to review cases and determine their appropriateness and quality of professional care






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






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






32. 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






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






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






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






36. Working diagnosis which is not yet est.






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






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






39. 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`






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






41. Durable Medical Equipment Regional Carrier






42. Working diagnosis which is not yet est.






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






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






45. 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






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






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






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






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






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