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Test your basic knowledge |
Medical Billing Claims Basics
Start Test
Study First
Subject
:
medical-transcription
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. Process of looking over a cliam to assess payment amounts
Review
Aging Report
Group Provider Number
Paper Claims
2. 1. Blocks 1-13=patient info 2.Blocks 14-33=physicians info
Provider Identification Number (PIN)
Adjudicate
Skip
Claim Form is divided into 2 sections
3. 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
Non-Covered Benefits
Group Practice
Paper Claims
Unarthorized Benefit
4. 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
Medical Necessity Edit Checks
Assignment of Benefits
Cycle Billing
Electronic Claim
5. Process of converting diagnoses - procedures - and services into numeric and alpha-numeric characters
Clearinghouse
Coding
Accepted Assignments
Medical Necessity Edit Checks
6. Billing for each item service provided to a patient in accourdance with insurance carriers' policies
Encounter Form(Superbill)
Assignment
Component Billing
Ledger Card
7. Describes the service billed and includes a breakdown of how payment is determined
Explaination of Benefits
Fee-for-Service
Civil Monetary Penalities Law (CMPL)
Fiscal Intermediary (FI)
8. Amount charged by a practice when providing services
Actual Charge
Batching
Qualified Diagnosis
Review
9. Accounts that are subject to charges from time to time
Review
Open Account
Assignment
Itemized Statement
10. 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
Open Account
Unique Provider Identification Number(UPIN)
Non-Covered Benefits
Explaination of Benefits
11. Term for processing payment
Open Account
Adjudicate
Unique Provider Identification Number(UPIN)
Assignment
12. Request or message to remind a patient that the account is over due or delinquent
Cycle Billing
Electronic Claim
Dun/Dunning
Actual Charge
13. The amount set by the carrier for the reimbursement of services
Allowed Charge
Claim Form is divided into 2 sections
Explaination of Benefits
Medical Necessity Edit Checks
14. Statement of a patient's account history - showing DOS - detailed chrages - payments - day insurance claims was submitted - applicable adjusments - and account balances
Clearinghouse
Qualified Diagnosis
Itemized Statement
Adjudicate
15. 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
Itemized Statement
Civil Monetary Penalities Law (CMPL)
Life Cycle of Insurance Claims
Allowed Charge
16. Breaking the account receivable amounts into portions for billing at a specific date of the month
Unit Count
Conversion Factor
Cycle Billing
Inquiry
17. Major surgical procedures that typically have a follow-up period of 30 - 60 - 90 - 120 days
Adjustment Codes
Adjustment
Global Procedures
Exclusions and Limatations
18. Using ICD-9 codes to hughest degree
Truth in Lending
Aging Accounts
Global Period
Specificty
19. Bundling edits by CMS to combine various component items with a major service or procedure
Fee Schedule
Employer Indentification Number (EIN)
Batching
Correct Coding Initiative (CCI)
20. Once claim is approved for payment Remittance Advice(RA) is sent to the provider and EOB is mailed to the policyholder
The Patient Care Partnership(Patients Bill of Rights)
V.I. Payment
Fiscal Intermediary (FI)
Skip
21. CMS 1500 - became effective July 2007 -All third party payers accept it - Medicare requires all physicians to use it
Global Procedures
Coding
Universal Claim Form
Professional Courtesy
22. Federal Tax identification number - issued by internal revenue service -social security number used if employer doesn't have a EIN
Clearinghouse
Conversion Factor
Employer Indentification Number (EIN)
Dun/Dunning
23. 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
Cycle Billing
Coordination of Benefits (COB)
Encounter Form(Superbill)
Adjustment
24. Means to report the number of times a service was provided on the same date of service to the same patient
Health Care Clearinghouse
Itemized Statement
Adjustment Codes
Unit Count
25. Working diagnosis which is not yet est.
Skip
Qualified Diagnosis
Exclusions and Limatations
Performing Provider Identification Number(PPIN)
26. Term for processing payment
Commerical Payer
Correct Coding Initiative (CCI)
Adjudicate
Electronic Claim
27. Money amount determined by dividing the actual charge of a service or procedure by a relative unit
Adjudicate
Conversion Factor
Global Procedures
Fiscal Intermediary (FI)
28. Request sent to an insurance comapany or other payer asking that a submitted claim be reconsidered for payment or processing
Cycle Billing
Appeal
Coding
Batching
29. Percent of payment held back for a risk account in the HMO program
Appeal
Claim Form is divided into 2 sections
Withhold Incentive
Correct Coding Initiative (CCI)
30. Provider agrees to accept what insurance company approves as payment in full for the claim
Accepted Assignments
Claim Form is divided into 2 sections
Commerical Payer
Allowed Charge
31. 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`
Medical Necessity
Posting
Paper Claims
Group Practice
32. Promote interest and well being of the patients and residents of healthcare facility
Collection Ratio
Fee-for-Service
Conversion Factor
The Patient Care Partnership(Patients Bill of Rights)
33. Combing lesser services with a major service in order for one charge to include that variety of service
DMERC
Explaination of Benefits
Bundling
Unit Count
34. Provider agrees to accept what insurance company approves as payment in full for the claim
Explaination of Benefits
Provider Identification Number (PIN)
Accepted Assignments
Profile
35. Specific time frames assigned to a code by an insurance comapny before additional payment will be made following a surgical procedure
Posting
Global Period
Component Billing
Employer Indentification Number (EIN)
36. 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'
TWIP
Global Period
Medical Necessity
Allowed Charge
37. Bundling edits by CMS to combine various component items with a major service or procedure
EPSDT
Itemized Statement
Correct Coding Initiative (CCI)
Withhold Incentive
38. When two companies work together to decided payment of benefits
Assignment
Coordination of Benefits (COB)
Bundling
The Patient Care Partnership(Patients Bill of Rights)
39. Passed by the federal government to prosecute cases of Medicaid fraud
Civil Monetary Penalities Law (CMPL)
Customary Charge
Commerical Payer
Group Practice
40. 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
Explaination of Benefits
Assignment of Benefits
Performing Provider Identification Number(PPIN)
Group Provider Number
41. Process of converting diagnoses - procedures - and services into numeric and alpha-numeric characters
Allowed Charge
State License Number
Unarthorized Benefit
Coding
42. Request or message to remind a patient that the account is over due or delinquent
Ledger Card
Dun/Dunning
Paper Claims
Fee-for-Service
43. Process of assesing medical services to assure medical necessity and the appropriateness of treatment
Utilization review
Employer Indentification Number (EIN)
Group Practice
Withhold Incentive
44. 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
Basic Billing and Reimbursment Steps
Clearinghouse
Dun/Dunning
Ranking Code
45. Discount or fee exception given to a patient at the discretion of the physician
Civil Monetary Penalities Law (CMPL)
Professional Courtesy
Encounter Form(Superbill)
Fee Schedule
46. Once claim is approved for payment Remittance Advice(RA) is sent to the provider and EOB is mailed to the policyholder
Cycle Billing
Qualified Diagnosis
Employer Indentification Number (EIN)
V.I. Payment
47. Billing for each item service provided to a patient in accourdance with insurance carriers' policies
The Patient Care Partnership(Patients Bill of Rights)
Bundling
Component Billing
Timely Filing Clause
48. 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
Open Account
Medical Necessity Edit Checks
V.I. Payment
State License Number
49. Conditions - situations - and services not covered by the insurance carrier
Withhold Incentive
Fee Schedule
Exclusions and Limatations
Unique Provider Identification Number(UPIN)
50. Discount or fee exception given to a patient at the discretion of the physician
Group Provider Number
Professional Courtesy
Global Period
Global Period