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






2. Early and Periodic Screenings - Diagnosis - and Treatment






3. 1. Blocks 1-13=patient info 2.Blocks 14-33=physicians info






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






5. Assigned to the physician by Medicare program






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






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






8. 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






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






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






11. 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






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






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






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






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






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






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






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






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






20. 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






21. 1. Blocks 1-13=patient info 2.Blocks 14-33=physicians info






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






23. Amount charged by a practice when providing services






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






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






26. 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






27. Using ICD-9 codes to hughest degree






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






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






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






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






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






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






35. Term for processing payment






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






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






38. 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






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






40. Superbill or Encounter Form






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






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






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






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






45. Take what insurance pays






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






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






48. Early and Periodic Screenings - Diagnosis - and Treatment






49. 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






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