SUBJECTS
|
BROWSE
|
CAREER CENTER
|
POPULAR
|
JOIN
|
LOGIN
Business Skills
|
Soft Skills
|
Basic Literacy
|
Certifications
About
|
Help
|
Privacy
|
Terms
|
Email
Search
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. Amount representing the charge most frequently used by a physician in a given periord of time
Customary Charge
Actual Charge
Group Practice
Fee Slip
2. Authorization by a policyholder to allow a thrid-party payer to pay benefits to a health care provider
Collection Ratio
Exclusions and Limatations
Assignment
Actual Charge
3. Request sent to an insurance comapany or other payer asking that a submitted claim be reconsidered for payment or processing
Provider Identification Number (PIN)
Appeal
Conversion Factor
Performing Provider Identification Number(PPIN)
4. Durable Medical Equipment Regional Carrier
Remittance Advice(RA)
DMERC
Adjustment
Life Cycle of Insurance Claims
5. Provider agrees to accept what insurance company approves as payment in full for the claim
Civil Monetary Penalities Law (CMPL)
Medical Necessity Edit Checks
Accepted Assignments
Peer Review Orginization (PRO)
6. 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`
Correct Coding Initiative (CCI)
Paper Claims
Open Account
Itemized Statement
7. 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`
Claim Form is divided into 2 sections
Basic Billing and Reimbursment Steps
Paper Claims
Fee Slip
8. Analysis of accounts receivable that indicate delinquency of 60 - 90 - 120 days
Adjustment Codes
Aging Accounts
Health Care Clearinghouse
Aging Report
9. Combing lesser services with a major service in order for one charge to include that variety of service
Collection Ratio
Aging Accounts
Adjustment
Bundling
10. 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'
Itemized Statement
EPSDT
Withhold Incentive
Medical Necessity
11. Amount of time allowed by an insurance company for a claim to be submitted for a payment from the date of service
V.I. Payment
Timely Filing Clause
Appeal
Ranking Code
12. Billing for each item service provided to a patient in accourdance with insurance carriers' policies
Component Billing
Employer Indentification Number (EIN)
Batching
Fee Slip
13. Number assigned by insurance companies to a physician who renders service to patients
Coding
Provider Identification Number (PIN)
Adjudicate
Profile
14. Term for processing payment
Adjudicate
Universal Claim Form
Clearinghouse
Fiscal Intermediary (FI)
15. Reimbursement directly sent from payer to provider
Customary Charge
Remittance Advice(RA)
Assignment of Benefits
Profile
16. Discount or fee exception given to a patient at the discretion of the physician
Bundling
Correct Coding Initiative (CCI)
Professional Courtesy
Customary Charge
17. 1. Blocks 1-13=patient info 2.Blocks 14-33=physicians info
Dun/Dunning
Commerical Payer
Claim Form is divided into 2 sections
The Patient Care Partnership(Patients Bill of Rights)
18. Specific time frames assigned to a code by an insurance comapny before additional payment will be made following a surgical procedure
Ledger Card
Aging Report
Global Period
Fee Slip
19. Physician must obtain this number in order to practice within a state
Fee Schedule
DMERC
State License Number
Group Provider Number
20. Major surgical procedures that typically have a follow-up period of 30 - 60 - 90 - 120 days
Appeal
Claim Form is divided into 2 sections
Global Procedures
Electronic Claim
21. Billing for each item service provided to a patient in accourdance with insurance carriers' policies
State License Number
Skip
Health Care Clearinghouse
Component Billing
22. A report to track claim status of patient accounts and to identify individual accounts requiring additional workup for payments or write-offs
Paper Claims
Unit Count
Aging Report
Posting
23. Amount charged by a practice when providing services
Insurance Adjustment(write off)
Actual Charge
Posting
Assignment of Benefits
24. Once claim is approved for payment Remittance Advice(RA) is sent to the provider and EOB is mailed to the policyholder
Global Period
Adjustment
FECA
V.I. Payment
25. Provider agrees to accept what insurance company approves as payment in full for the claim
Encounter Form(Superbill)
Insurance Adjustment(write off)
Accepted Assignments
FECA
26. Discount or fee exception given to a patient at the discretion of the physician
Batching
Fee-for-Service
Professional Courtesy
Adjudicate
27. Record to track patients charges - payments - adjustments - and balance due
Cycle Billing
Ledger Card
Assignment
Global Period
28. Passed by the federal government to prosecute cases of Medicaid fraud
Coordination of Benefits (COB)
Assignment of Benefits
Appeal
Civil Monetary Penalities Law (CMPL)
29. Established proce set by a medical practice for proefessional services
Correct Coding Initiative (CCI)
Medical Necessity Edit Checks
Fee Schedule
Adjustment
30. Term for processing payment
Unarthorized Benefit
Unique Provider Identification Number(UPIN)
Review
Adjudicate
31. Number assigned by insurance companies to a physician who renders service to patients
Batching
Adjustment
Provider Identification Number (PIN)
Coordination of Benefits (COB)
32. Private health insurance company or employer-based group insurance plan that pays claims for eligible participants
Paper Claims
Group Practice
Commerical Payer
Conversion Factor
33. Record to track patients charges - payments - adjustments - and balance due
Coding
Allowed Charge
Ledger Card
Coordination of Benefits (COB)
34. 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
Basic Billing and Reimbursment Steps
Medical Necessity Edit Checks
Professional Courtesy
Suspended File Report
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
Health Care Clearinghouse
TWIP
Basic Billing and Reimbursment Steps
Inquiry
36. 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
Group Provider Number
Non-Covered Benefits
Insurance Adjustment(write off)
Unique Provider Identification Number(UPIN)
37. Process of converting diagnoses - procedures - and services into numeric and alpha-numeric characters
Employer Indentification Number (EIN)
Coding
Inquiry
State License Number
38. List of CPT codes used by a physician with a corresponding fee that is usually calculated and maintained by a third-party payer
Assignment of Benefits
Accepted Assignments
Profile
EPSDT
39. 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
DMERC
Paper Claims
Fee-for-Service
Conversion Factor
40. Company that translates electroinc transactions between the standard formats and code set required under HIPAA and nonstandard formats and code sets
Commerical Payer
Health Care Clearinghouse
Timely Filing Clause
Fee-for-Service
41. Combing lesser services with a major service in order for one charge to include that variety of service
Health Care Clearinghouse
Truth in Lending
V.I. Payment
Bundling
42. Deferred or delayed processing method for inputting data a retrieval at a later date
Fiscal Intermediary (FI)
Batching
Fee Slip
Itemized Statement
43. Agreement between the patoent and the physician regarding monthly installments to pay a bill
Ledger Card
Truth in Lending
Component Billing
Suspended File Report
44. Amount charged by a practice when providing services
Unit Count
Actual Charge
Coding
The Patient Care Partnership(Patients Bill of Rights)
45. Federal Tax identification number - issued by internal revenue service -social security number used if employer doesn't have a EIN
Allowed Charge
Medical Necessity
Employer Indentification Number (EIN)
Timely Filing Clause
46. 1. Blocks 1-13=patient info 2.Blocks 14-33=physicians info
EPSDT
Suspended File Report
Claim Form is divided into 2 sections
Assignment
47. Listing of diagnosis - procedures - and charges for a patients visit
Coordination of Benefits (COB)
Encounter Form(Superbill)
Correct Coding Initiative (CCI)
Life Cycle of Insurance Claims
48. Deferred or delayed processing method for inputting data a retrieval at a later date
FECA
Fee Slip
Adjustment
Batching
49. Process of assesing medical services to assure medical necessity and the appropriateness of treatment
Medical Necessity
Actual Charge
Aging Report
Utilization review
50. Promote interest and well being of the patients and residents of healthcare facility
DMERC
The Patient Care Partnership(Patients Bill of Rights)
Bundling
Dun/Dunning