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






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






3. 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






4. Using ICD-9 codes to hughest degree






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






6. Federal Employees' Compensation Act






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






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






9. 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






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






11. 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






12. Working diagnosis which is not yet est.






13. CMS 1500 - became effective July 2007 -All third party payers accept it - Medicare requires all physicians to use it






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






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






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






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






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






19. Take what insurance pays






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






21. CMS 1500 - became effective July 2007 -All third party payers accept it - Medicare requires all physicians to use it






22. 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






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






24. 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






25. 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






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






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






28. Working diagnosis which is not yet est.






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






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






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






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






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






34. 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






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






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






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






38. Federal Employees' Compensation Act






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






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






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






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






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






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






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






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






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






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






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






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