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






2. Superbill or Encounter Form






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






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






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






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






7. 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






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






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






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






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






12. 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






13. Using ICD-9 codes to hughest degree






14. 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






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






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






17. 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'






18. 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






19. 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






20. Amount charged by a practice when providing services






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






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






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






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






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






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






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






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






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






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






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






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






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






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






35. 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






36. 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`






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






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






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






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






41. Private health insurance company or employer-based group insurance plan that pays claims for eligible participants






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






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






44. Take what insurance pays






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






46. 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






47. 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






48. Working diagnosis which is not yet est.






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






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