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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. Billing for each item service provided to a patient in accourdance with insurance carriers' policies
State License Number
Component Billing
DMERC
FECA
2. 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`
Medical Necessity Edit Checks
Batching
State License Number
Paper Claims
3. 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
Remittance Advice(RA)
Adjustment
Review
DMERC
4. Checking or tracing a claim sent to an insurance comapany to determine payment or processing status
Ledger Card
Encounter Form(Superbill)
Inquiry
Global Period
5. List of CPT codes used by a physician with a corresponding fee that is usually calculated and maintained by a third-party payer
Profile
Unit Count
Cycle Billing
Accepted Assignments
6. Durable Medical Equipment Regional Carrier
Allowed Charge
DMERC
Remittance Advice(RA)
Exclusions and Limatations
7. Provider agrees to accept what insurance company approves as payment in full for the claim
Fee Slip
Accepted Assignments
Exclusions and Limatations
Fiscal Intermediary (FI)
8. Bundling edits by CMS to combine various component items with a major service or procedure
Adjustment
Group Provider Number
Correct Coding Initiative (CCI)
Component Billing
9. Conditions - situations - and services not covered by the insurance carrier
DMERC
Exclusions and Limatations
Commerical Payer
Correct Coding Initiative (CCI)
10. A report to track claim status of patient accounts and to identify individual accounts requiring additional workup for payments or write-offs
Coding
Bundling
TWIP
Aging Report
11. Percent of payment held back for a risk account in the HMO program
Inquiry
Assignment
Specificty
Withhold Incentive
12. Private health insurance company or employer-based group insurance plan that pays claims for eligible participants
Commerical Payer
Performing Provider Identification Number(PPIN)
Universal Claim Form
Inquiry
13. Amount charged by a practice when providing services
Actual Charge
Open Account
Dun/Dunning
Group Provider Number
14. CMS 1500 - became effective July 2007 -All third party payers accept it - Medicare requires all physicians to use it
Fee-for-Service
Universal Claim Form
Global Procedures
Truth in Lending
15. Combing lesser services with a major service in order for one charge to include that variety of service
Professional Courtesy
Bundling
Dun/Dunning
Correct Coding Initiative (CCI)
16. 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
Specificty
Clearinghouse
Group Practice
Life Cycle of Insurance Claims
17. Assigned to the physician by Medicare program
Unique Provider Identification Number(UPIN)
TWIP
Encounter Form(Superbill)
EPSDT
18. Billing for each item service provided to a patient in accourdance with insurance carriers' policies
Component Billing
Timely Filing Clause
Collection Ratio
Adjustment Codes
19. 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
Assignment
Group Provider Number
Unit Count
Unit Count
20. Established proce set by a medical practice for proefessional services
Utilization review
Fee Schedule
Accepted Assignments
Timely Filing Clause
21. Once claim is approved for payment Remittance Advice(RA) is sent to the provider and EOB is mailed to the policyholder
Medical Necessity
Provider Identification Number (PIN)
Suspended File Report
V.I. Payment
22. Assigned to the physician by Medicare program
Unarthorized Benefit
Unique Provider Identification Number(UPIN)
Performing Provider Identification Number(PPIN)
Review
23. 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
Fee-for-Service
Collection Ratio
Profile
Adjustment Codes
24. Listing service in their order of importance by dates of service and values. Highest charge to lowest charge
Ranking Code
Explaination of Benefits
Dun/Dunning
Appeal
25. Request or message to remind a patient that the account is over due or delinquent
Peer Review Orginization (PRO)
Cycle Billing
Coding
Dun/Dunning
26. Bundling edits by CMS to combine various component items with a major service or procedure
Encounter Form(Superbill)
Appeal
Global Procedures
Correct Coding Initiative (CCI)
27. Checking or tracing a claim sent to an insurance comapany to determine payment or processing status
Insurance Adjustment(write off)
Professional Courtesy
Allowed Charge
Inquiry
28. Company that translates electroinc transactions between the standard formats and code set required under HIPAA and nonstandard formats and code sets
Global Procedures
Health Care Clearinghouse
Claim Form is divided into 2 sections
Global Period
29. Means to report the number of times a service was provided on the same date of service to the same patient
Unit Count
Provider Identification Number (PIN)
DMERC
Life Cycle of Insurance Claims
30. 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`
Adjustment
Assignment of Benefits
Coordination of Benefits (COB)
Paper Claims
31. Analysis of accounts receivable that indicate delinquency of 60 - 90 - 120 days
Unarthorized Benefit
Life Cycle of Insurance Claims
DMERC
Aging Accounts
32. 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
Batching
Ranking Code
Appeal
Life Cycle of Insurance Claims
33. Provider agrees to accept what insurance company approves as payment in full for the claim
Coordination of Benefits (COB)
Coding
DMERC
Accepted Assignments
34. Private health insurance company or employer-based group insurance plan that pays claims for eligible participants
Commerical Payer
Itemized Statement
The Patient Care Partnership(Patients Bill of Rights)
Aging Accounts
35. Breaking the account receivable amounts into portions for billing at a specific date of the month
Unarthorized Benefit
Truth in Lending
Cycle Billing
Explaination of Benefits
36. Major surgical procedures that typically have a follow-up period of 30 - 60 - 90 - 120 days
Aging Accounts
Global Procedures
Aging Report
Group Practice
37. 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
Appeal
Civil Monetary Penalities Law (CMPL)
Group Practice
Coordination of Benefits (COB)
38. Deferred or delayed processing method for inputting data a retrieval at a later date
Batching
Universal Claim Form
Professional Courtesy
Encounter Form(Superbill)
39. Process of converting diagnoses - procedures - and services into numeric and alpha-numeric characters
Coding
Withhold Incentive
Dun/Dunning
Accepted Assignments
40. Listing of claims that have incorrect information such as posting error or missing information to process a claim
Bundling
Suspended File Report
Paper Claims
Clearinghouse
41. Breaking the account receivable amounts into portions for billing at a specific date of the month
Adjudicate
Cycle Billing
Truth in Lending
Adjustment Codes
42. Process of assesing medical services to assure medical necessity and the appropriateness of treatment
Cycle Billing
Withhold Incentive
Utilization review
Coding
43. Number assigned by insurance companies to a physician who renders service to patients
Unique Provider Identification Number(UPIN)
Health Care Clearinghouse
Provider Identification Number (PIN)
Group Provider Number
44. Using ICD-9 codes to hughest degree
Adjustment
Component Billing
Encounter Form(Superbill)
Specificty
45. Procedure or services provided without proper authorizationor was not covered by a current authorization -denied - provider can't bill patient for charges
Ranking Code
Explaination of Benefits
Group Provider Number
Unarthorized Benefit
46. 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
Unarthorized Benefit
Medical Necessity Edit Checks
Non-Covered Benefits
Clearinghouse
47. Listing of diagnosis - procedures - and charges for a patients visit
Correct Coding Initiative (CCI)
Profile
Encounter Form(Superbill)
Adjustment Codes
48. Codes used by insurance compaines to explain actions taken on a Remittance Notice
Peer Review Orginization (PRO)
Skip
Adjustment Codes
Health Care Clearinghouse
49. Early and Periodic Screenings - Diagnosis - and Treatment
Civil Monetary Penalities Law (CMPL)
Allowed Charge
EPSDT
Accepted Assignments
50. Codes used by insurance compaines to explain actions taken on a Remittance Notice
Explaination of Benefits
DMERC
Adjustment Codes
Professional Courtesy