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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. Established proce set by a medical practice for proefessional services






2. Federal Employees' Compensation Act






3. Term for processing payment






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






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






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






7. Passed by the federal government to prosecute cases of Medicaid fraud






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






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






10. 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






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






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






13. Assigned to the physician by Medicare program






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






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






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






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






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






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






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






21. Working diagnosis which is not yet est.






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






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






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






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






26. 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






27. Federal Employees' Compensation Act






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






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






30. 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






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






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






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






34. Working diagnosis which is not yet est.






35. 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






36. 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






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






38. 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






39. Durable Medical Equipment Regional Carrier






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






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






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






43. 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






44. 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






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






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






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






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






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






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







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