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. Number is used instead of the individuals physician's number for the performing provider who is a member of a group practice that sybmits claims to insurance complanies under the group name






2. 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






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






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






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






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






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






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






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






10. Term for processing payment






11. 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






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






13. Take what insurance pays






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






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






16. 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






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






18. Reimbursement directly sent from payer to provider






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






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






21. Amount charged by a practice when providing services






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






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






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






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






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






27. Assigned to the physician by Medicare program






28. 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'






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






30. 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






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






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






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






34. Superbill or Encounter Form






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






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






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






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






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






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






41. Assigned to the physician by Medicare program






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






43. 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






44. 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






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






46. Means to report the number of times a service was provided on the same date of service to the same patient






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






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






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






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