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






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






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






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






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






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






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






8. Early and Periodic Screenings - Diagnosis - and Treatment






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






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






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






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






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






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






15. Working diagnosis which is not yet est.






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






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






18. 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'






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






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






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






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






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






24. 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






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






26. Superbill or Encounter Form






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






28. Assigned to the physician by Medicare program






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






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






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






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






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






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






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






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






37. Early and Periodic Screenings - Diagnosis - and Treatment






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






39. Durable Medical Equipment Regional Carrier






40. 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'






41. 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






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






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






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






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






46. 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






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






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






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






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