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






2. 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






3. 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






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






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






6. 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






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






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






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






10. Request sent to an insurance comapany or other payer asking that a submitted claim be reconsidered for payment or processing






11. Physician must obtain this number in order to practice within a state






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






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






14. 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






15. 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






16. 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






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






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






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






20. Reimbursement directly sent from payer to provider






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






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






23. 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`






24. Term for processing payment






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






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






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






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






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






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






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






32. Reimbursement directly sent from payer to provider






33. 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






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






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






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






38. Using ICD-9 codes to hughest degree






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






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






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






42. 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






43. Assigned to the physician by Medicare program






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






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






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






47. Early and Periodic Screenings - Diagnosis - and Treatment






48. Physician must obtain this number in order to practice within a state






49. 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






50. 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'