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






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






3. Amount charged by a practice when providing services






4. Insurance company that bids for a contract with CMS to handle the Medicare program in a specific area






5. 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'






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






7. Accounts that are subject to charges from time to time






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






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






10. 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






11. Take what insurance pays






12. Reimbursement directly sent from payer to provider






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






14. 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'






15. 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






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






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






18. 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






19. Early and Periodic Screenings - Diagnosis - and Treatment






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






21. Combing lesser services with a major service in order for one charge to include that variety of service






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






23. 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`






24. 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






25. 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






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






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






28. Insurance company that bids for a contract with CMS to handle the Medicare program in a specific area






29. Company that translates electroinc transactions between the standard formats and code set required under HIPAA and nonstandard formats and code sets






30. Take what insurance pays






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






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






33. Using ICD-9 codes to hughest degree






34. List of CPT codes used by a physician with a corresponding fee that is usually calculated and maintained by a third-party payer






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






36. 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






37. Amount charged by a practice when providing services






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






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






40. Combing lesser services with a major service in order for one charge to include that variety of service






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






42. Term for processing payment






43. Assigned to the physician by Medicare program






44. 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






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






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. List of CPT codes used by a physician with a corresponding fee that is usually calculated and maintained by a third-party payer






48. Durable Medical Equipment Regional Carrier






49. 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






50. Describes the service billed and includes a breakdown of how payment is determined