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






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






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






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






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






6. Take what insurance pays






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






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






9. 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






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






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






12. Amount charged by a practice when providing services






13. Amount representing the charge most frequently used by a physician in a given periord of time






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






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






16. Assigned to the physician by Medicare program






17. 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






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






19. Amount corrected on a patient ledger due to an error or a difference in the amount billed by a practice and the amount allowed by the insurance company






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






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






22. Assigned to the physician by Medicare program






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






24. Amount corrected on a patient ledger due to an error or a difference in the amount billed by a practice and the amount allowed by the insurance company






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






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






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






28. Working diagnosis which is not yet est.






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






30. Working diagnosis which is not yet est.






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






32. Using ICD-9 codes to hughest degree






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






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






35. 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






36. 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






37. 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






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






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






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






41. Term for processing payment






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






43. Term for processing payment






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






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






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






47. 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






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






49. 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






50. 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