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






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






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






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






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






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






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






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






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






11. 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






12. 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






13. Superbill or Encounter Form






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






15. Assigned to the physician by Medicare program






16. 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






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






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






19. Amount required by an insurance company that must be taken off a patient's acoount based on actual agreements and participation






20. 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`






21. Amount charged by a practice when providing services






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






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. 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






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






26. Federal Employees' Compensation Act






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






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






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






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






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






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






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






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






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






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






37. 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






38. 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






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






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






41. 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






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






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






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






45. 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






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






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






48. Process of converting diagnoses - procedures - and services into numeric and alpha-numeric characters






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






50. Durable Medical Equipment Regional Carrier