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






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






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






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






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






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






7. Amount charged by a practice when providing services






8. Early and Periodic Screenings - Diagnosis - and Treatment






9. Take what insurance pays






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






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






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






13. 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






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






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






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






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






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






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






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






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






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






23. 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






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






25. 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`






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






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






28. 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






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






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






31. Take what insurance pays






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






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






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






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






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






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






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






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






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






41. 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






42. 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






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






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






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






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






47. 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






48. Amount charged by a practice when providing services






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






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