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Test your basic knowledge |
Medical Billing Claims Basics
Start Test
Study First
Subject
:
medical-transcription
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. Promote interest and well being of the patients and residents of healthcare facility
The Patient Care Partnership(Patients Bill of Rights)
Peer Review Orginization (PRO)
Accepted Assignments
Paper Claims
2. 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'
Skip
Posting
Basic Billing and Reimbursment Steps
Medical Necessity
3. Conditions - situations - and services not covered by the insurance carrier
Customary Charge
Group Provider Number
Exclusions and Limatations
Cycle Billing
4. Listing service in their order of importance by dates of service and values. Highest charge to lowest charge
Ranking Code
Qualified Diagnosis
Life Cycle of Insurance Claims
Timely Filing Clause
5. 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
Employer Indentification Number (EIN)
Group Provider Number
Batching
FECA
6. 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'
Withhold Incentive
Medical Necessity
Health Care Clearinghouse
Commerical Payer
7. Procedure or services provided without proper authorizationor was not covered by a current authorization -denied - provider can't bill patient for charges
Unit Count
State License Number
Universal Claim Form
Unarthorized Benefit
8. Working diagnosis which is not yet est.
Life Cycle of Insurance Claims
Group Provider Number
Assignment of Benefits
Qualified Diagnosis
9. Traditional method ised by providers for submissions of charges to insurance companies -CMS 1500 -few plans accept encounter forms Medicare will only acccept CMS 1500`
Professional Courtesy
Remittance Advice(RA)
Actual Charge
Paper Claims
10. Private health insurance company or employer-based group insurance plan that pays claims for eligible participants
Commerical Payer
Appeal
Exclusions and Limatations
Assignment
11. Combing lesser services with a major service in order for one charge to include that variety of service
Inquiry
Profile
Medical Necessity Edit Checks
Bundling
12. CMS 1500 - became effective July 2007 -All third party payers accept it - Medicare requires all physicians to use it
Inquiry
Universal Claim Form
Adjustment Codes
Batching
13. Federal Tax identification number - issued by internal revenue service -social security number used if employer doesn't have a EIN
Ranking Code
Professional Courtesy
Utilization review
Employer Indentification Number (EIN)
14. Combing lesser services with a major service in order for one charge to include that variety of service
Qualified Diagnosis
Skip
Appeal
Bundling
15. Number assigned by insurance companies to a physician who renders service to patients
Professional Courtesy
Component Billing
Aging Report
Provider Identification Number (PIN)
16. Relationship between the amount of money owed and the amount of money collected
Itemized Statement
Employer Indentification Number (EIN)
Skip
Collection Ratio
17. Provider agrees to accept what insurance company approves as payment in full for the claim
Bundling
Accepted Assignments
Encounter Form(Superbill)
DMERC
18. Passed by the federal government to prosecute cases of Medicaid fraud
Civil Monetary Penalities Law (CMPL)
Encounter Form(Superbill)
Batching
TWIP
19. 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
Commerical Payer
Group Practice
Suspended File Report
Timely Filing Clause
20. Private health insurance company or employer-based group insurance plan that pays claims for eligible participants
Life Cycle of Insurance Claims
Commerical Payer
Exclusions and Limatations
Aging Report
21. When two companies work together to decided payment of benefits
TWIP
Coordination of Benefits (COB)
Skip
Accepted Assignments
22. Agreement between the patoent and the physician regarding monthly installments to pay a bill
Assignment of Benefits
Clearinghouse
Fiscal Intermediary (FI)
Truth in Lending
23. Established proce set by a medical practice for proefessional services
Ranking Code
Truth in Lending
Paper Claims
Fee Schedule
24. Electronic or paper-based report of payment sent by the payer to the provider
Skip
Adjustment Codes
Remittance Advice(RA)
Profile
25. Listing service in their order of importance by dates of service and values. Highest charge to lowest charge
Ranking Code
State License Number
Coding
Ledger Card
26. Amount charged by a practice when providing services
Unarthorized Benefit
Timely Filing Clause
Insurance Adjustment(write off)
Actual Charge
27. Take what insurance pays
Commerical Payer
TWIP
Fiscal Intermediary (FI)
Unique Provider Identification Number(UPIN)
28. Superbill or Encounter Form
Suspended File Report
Customary Charge
Aging Accounts
Fee Slip
29. Reimbursement directly sent from payer to provider
Skip
Performing Provider Identification Number(PPIN)
Assignment of Benefits
Non-Covered Benefits
30. When two companies work together to decided payment of benefits
Assignment of Benefits
Coordination of Benefits (COB)
Truth in Lending
Clearinghouse
31. Assigned to the physician by Medicare program
Itemized Statement
Global Period
Unique Provider Identification Number(UPIN)
Unarthorized Benefit
32. Conditions - situations - and services not covered by the insurance carrier
Unique Provider Identification Number(UPIN)
Exclusions and Limatations
Skip
Global Period
33. State based group of physicians working under government guideline to review cases and determine their appropriateness and quality of professional care
Aging Report
Posting
Aging Accounts
Peer Review Orginization (PRO)
34. Billing for each item service provided to a patient in accourdance with insurance carriers' policies
Unique Provider Identification Number(UPIN)
Conversion Factor
Correct Coding Initiative (CCI)
Component Billing
35. The amount set by the carrier for the reimbursement of services
Allowed Charge
Withhold Incentive
Unit Count
Customary Charge
36. Analysis of accounts receivable that indicate delinquency of 60 - 90 - 120 days
TWIP
Allowed Charge
Aging Accounts
Conversion Factor
37. Analysis of accounts receivable that indicate delinquency of 60 - 90 - 120 days
Aging Accounts
Component Billing
Group Practice
Correct Coding Initiative (CCI)
38. 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
Truth in Lending
Ranking Code
Clearinghouse
Exclusions and Limatations
39. Amount required by an insurance company that must be taken off a patient's acoount based on actual agreements and participation
Provider Identification Number (PIN)
Review
Insurance Adjustment(write off)
Unit Count
40. Process or tansferring account information from a journal to a ledger
Posting
Medical Necessity Edit Checks
Fiscal Intermediary (FI)
Actual Charge
41. Describes the service billed and includes a breakdown of how payment is determined
Claim Form is divided into 2 sections
Withhold Incentive
Explaination of Benefits
Specificty
42. Company that translates electroinc transactions between the standard formats and code set required under HIPAA and nonstandard formats and code sets
Accepted Assignments
Timely Filing Clause
Health Care Clearinghouse
TWIP
43. Provider agrees to accept what insurance company approves as payment in full for the claim
Unique Provider Identification Number(UPIN)
Accepted Assignments
Timely Filing Clause
Profile
44. Traditional method ised by providers for submissions of charges to insurance companies -CMS 1500 -few plans accept encounter forms Medicare will only acccept CMS 1500`
Electronic Claim
Paper Claims
Itemized Statement
Correct Coding Initiative (CCI)
45. Term for processing payment
Civil Monetary Penalities Law (CMPL)
Appeal
Adjudicate
Accepted Assignments
46. Breaking the account receivable amounts into portions for billing at a specific date of the month
Timely Filing Clause
Group Practice
Performing Provider Identification Number(PPIN)
Cycle Billing
47. Patient who owes a balance on the account who has moved without a forwarding address
Skip
Life Cycle of Insurance Claims
Aging Accounts
Unique Provider Identification Number(UPIN)
48. 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
Commerical Payer
Posting
Group Provider Number
Adjudicate
49. Process of looking over a cliam to assess payment amounts
Utilization review
Review
Fee Slip
Insurance Adjustment(write off)
50. 1. Blocks 1-13=patient info 2.Blocks 14-33=physicians info
Exclusions and Limatations
Claim Form is divided into 2 sections
Global Procedures
Peer Review Orginization (PRO)