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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. 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






2. Superbill or Encounter Form






3. Early and Periodic Screenings - Diagnosis - and Treatment






4. Take what insurance pays






5. 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






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






7. 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






8. 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






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






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






11. 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`






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






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






14. 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






15. Amount charged by a practice when providing services






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






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






18. Using ICD-9 codes to hughest degree






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






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






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






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






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






24. 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






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






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






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






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






29. 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






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






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






32. 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






33. 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






34. 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






35. Term for processing payment






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






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






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






39. Federal Employees' Compensation Act






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






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






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






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






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






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






46. Assigned to the physician by Medicare program






47. Working diagnosis which is not yet est.






48. Durable Medical Equipment Regional Carrier






49. Federal Employees' Compensation Act






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







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