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






2. 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






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






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






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






6. 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






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






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






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






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






11. 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






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






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






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






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






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






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






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






19. Superbill or Encounter Form






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






21. 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






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






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






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






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






26. Early and Periodic Screenings - Diagnosis - and Treatment






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






28. 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






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






30. Early and Periodic Screenings - Diagnosis - and Treatment






31. Amount charged by a practice when providing services






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






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






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






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






36. Federal Employees' Compensation Act






37. 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






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






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






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






41. 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






42. Durable Medical Equipment Regional Carrier






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






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






45. 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'






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






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






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






49. Durable Medical Equipment Regional Carrier






50. 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