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






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






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






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






5. Early and Periodic Screenings - Diagnosis - and Treatment






6. Describes the service billed and includes a breakdown of how payment is determined






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






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






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






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






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






12. Assigned to the physician by Medicare program






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






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






15. Amount charged by a practice when providing services






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






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






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






19. Record to track patients charges - payments - adjustments - and balance due






20. 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'






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






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






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. Amount charged by a practice when providing services






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






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






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






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






29. Term for processing payment






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






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






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






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






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






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






36. 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






37. 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






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






39. 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






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






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






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






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






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






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






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






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






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






49. 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`






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