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






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. When two companies work together to decided payment of benefits






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






5. Assigned to the physician by Medicare program






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






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






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






9. 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






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






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






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






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






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






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






16. Durable Medical Equipment Regional Carrier






17. Early and Periodic Screenings - Diagnosis - and Treatment






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






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






20. 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






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






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






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






24. 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






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






26. Assigned to the physician by Medicare program






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






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






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






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






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






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






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






34. 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'






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






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






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






38. 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






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






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






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






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






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






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






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






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






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






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






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






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