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






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






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






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






5. Federal Employees' Compensation Act






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






7. 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`






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






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






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






11. Amount charged by a practice when providing services






12. 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






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






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






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






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






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






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






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






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






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






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






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






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






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






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






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






28. 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






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






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






31. Using ICD-9 codes to hughest degree






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






33. 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






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






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






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






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






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






39. Early and Periodic Screenings - Diagnosis - and Treatment






40. Take what insurance pays






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






42. Amount charged by a practice when providing services






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






44. 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






45. Durable Medical Equipment Regional Carrier






46. 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






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






48. Assigned to the physician by Medicare program






49. Take what insurance pays






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