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. 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






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






3. 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






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






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






6. 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'






7. Private health insurance company or employer-based group insurance plan that pays claims for eligible participants






8. Durable Medical Equipment Regional Carrier






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






10. Early and Periodic Screenings - Diagnosis - and Treatment






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






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






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






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






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






16. 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






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






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






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






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






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






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






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






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






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






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






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






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






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






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






31. Term for processing payment






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






33. 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






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






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






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






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






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






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






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






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






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






43. Working diagnosis which is not yet est.






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






45. 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






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






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






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






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






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