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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. State based group of physicians working under government guideline to review cases and determine their appropriateness and quality of professional care
Customary Charge
Customary Charge
Claim Form is divided into 2 sections
Peer Review Orginization (PRO)
2. Company that translates electroinc transactions between the standard formats and code set required under HIPAA and nonstandard formats and code sets
Medical Necessity Edit Checks
Appeal
Health Care Clearinghouse
Dun/Dunning
3. Insurance company that bids for a contract with CMS to handle the Medicare program in a specific area
Accepted Assignments
Global Procedures
Fiscal Intermediary (FI)
Medical Necessity Edit Checks
4. Once claim is approved for payment Remittance Advice(RA) is sent to the provider and EOB is mailed to the policyholder
Medical Necessity Edit Checks
Ranking Code
V.I. Payment
Posting
5. Once claim is approved for payment Remittance Advice(RA) is sent to the provider and EOB is mailed to the policyholder
Aging Report
Specificty
Group Provider Number
V.I. Payment
6. Take what insurance pays
Bundling
Component Billing
TWIP
Ledger Card
7. Promote interest and well being of the patients and residents of healthcare facility
Coordination of Benefits (COB)
FECA
Health Care Clearinghouse
The Patient Care Partnership(Patients Bill of Rights)
8. State based group of physicians working under government guideline to review cases and determine their appropriateness and quality of professional care
Aging Report
Civil Monetary Penalities Law (CMPL)
Peer Review Orginization (PRO)
Coordination of Benefits (COB)
9. 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
Dun/Dunning
Itemized Statement
Non-Covered Benefits
Fiscal Intermediary (FI)
10. Major surgical procedures that typically have a follow-up period of 30 - 60 - 90 - 120 days
Unit Count
Utilization review
Global Procedures
Fiscal Intermediary (FI)
11. Number assigned by insurance companies to a physician who renders service to patients
Peer Review Orginization (PRO)
Life Cycle of Insurance Claims
Inquiry
Provider Identification Number (PIN)
12. Amount charged by a practice when providing services
Collection Ratio
Actual Charge
Profile
Encounter Form(Superbill)
13. Amount representing the charge most frequently used by a physician in a given periord of time
Customary Charge
Ranking Code
Commerical Payer
Aging Accounts
14. Billing for each item service provided to a patient in accourdance with insurance carriers' policies
Actual Charge
Non-Covered Benefits
Encounter Form(Superbill)
Component Billing
15. Request or message to remind a patient that the account is over due or delinquent
Accepted Assignments
Dun/Dunning
Fee-for-Service
Bundling
16. Assigned to the physician by Medicare program
Group Practice
Appeal
Unique Provider Identification Number(UPIN)
Performing Provider Identification Number(PPIN)
17. 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
Allowed Charge
Universal Claim Form
Global Procedures
Medical Necessity Edit Checks
18. Established proce set by a medical practice for proefessional services
Appeal
Fee Schedule
Component Billing
Profile
19. 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
Medical Necessity
Component Billing
Adjustment
Accepted Assignments
20. Billing for each item service provided to a patient in accourdance with insurance carriers' policies
Component Billing
Non-Covered Benefits
Electronic Claim
Exclusions and Limatations
21. Major surgical procedures that typically have a follow-up period of 30 - 60 - 90 - 120 days
Medical Necessity
Suspended File Report
Global Procedures
Ledger Card
22. Assigned to the physician by Medicare program
Unique Provider Identification Number(UPIN)
Coordination of Benefits (COB)
Cycle Billing
Adjustment
23. Amount of time allowed by an insurance company for a claim to be submitted for a payment from the date of service
Batching
DMERC
Timely Filing Clause
Profile
24. 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
Global Procedures
Explaination of Benefits
Exclusions and Limatations
Adjustment
25. Describes the service billed and includes a breakdown of how payment is determined
Conversion Factor
Explaination of Benefits
Ranking Code
Accepted Assignments
26. 1. Blocks 1-13=patient info 2.Blocks 14-33=physicians info
Non-Covered Benefits
Claim Form is divided into 2 sections
TWIP
Allowed Charge
27. Amount of time allowed by an insurance company for a claim to be submitted for a payment from the date of service
Specificty
Adjustment Codes
Utilization review
Timely Filing Clause
28. Working diagnosis which is not yet est.
Bundling
Itemized Statement
Qualified Diagnosis
Appeal
29. Provider agrees to accept what insurance company approves as payment in full for the claim
State License Number
Accepted Assignments
Aging Report
Review
30. Working diagnosis which is not yet est.
Batching
Component Billing
Qualified Diagnosis
Skip
31. Conditions - situations - and services not covered by the insurance carrier
Actual Charge
FECA
Profile
Exclusions and Limatations
32. Using ICD-9 codes to hughest degree
Claim Form is divided into 2 sections
Inquiry
Specificty
Universal Claim Form
33. Specific time frames assigned to a code by an insurance comapny before additional payment will be made following a surgical procedure
Global Period
Open Account
Bundling
Explaination of Benefits
34. Process or tansferring account information from a journal to a ledger
Posting
Non-Covered Benefits
Inquiry
Medical Necessity Edit Checks
35. 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
Claim Form is divided into 2 sections
Paper Claims
Coordination of Benefits (COB)
Basic Billing and Reimbursment Steps
36. 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
Life Cycle of Insurance Claims
Bundling
TWIP
Employer Indentification Number (EIN)
37. 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
Component Billing
Commerical Payer
Open Account
Clearinghouse
38. Deferred or delayed processing method for inputting data a retrieval at a later date
Basic Billing and Reimbursment Steps
Batching
Actual Charge
Encounter Form(Superbill)
39. Bundling edits by CMS to combine various component items with a major service or procedure
Medical Necessity Edit Checks
Correct Coding Initiative (CCI)
Universal Claim Form
Posting
40. Checking or tracing a claim sent to an insurance comapany to determine payment or processing status
Timely Filing Clause
Universal Claim Form
Inquiry
Cycle Billing
41. Term for processing payment
Qualified Diagnosis
Utilization review
Adjudicate
Group Practice
42. Discount or fee exception given to a patient at the discretion of the physician
Universal Claim Form
Assignment of Benefits
Utilization review
Professional Courtesy
43. Term for processing payment
Fee-for-Service
Adjudicate
Allowed Charge
Civil Monetary Penalities Law (CMPL)
44. When two companies work together to decided payment of benefits
Conversion Factor
Itemized Statement
Profile
Coordination of Benefits (COB)
45. Company that translates electroinc transactions between the standard formats and code set required under HIPAA and nonstandard formats and code sets
Electronic Claim
Allowed Charge
Health Care Clearinghouse
Adjudicate
46. List of CPT codes used by a physician with a corresponding fee that is usually calculated and maintained by a third-party payer
Profile
Claim Form is divided into 2 sections
Claim Form is divided into 2 sections
Ledger Card
47. 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
Coordination of Benefits (COB)
Performing Provider Identification Number(PPIN)
Non-Covered Benefits
Profile
48. Listing service in their order of importance by dates of service and values. Highest charge to lowest charge
Profile
Skip
Provider Identification Number (PIN)
Ranking Code
49. 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
Profile
Peer Review Orginization (PRO)
Fee-for-Service
Electronic Claim
50. 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
Fee-for-Service
Conversion Factor
Clearinghouse
Utilization review