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. Specific time frames assigned to a code by an insurance comapny before additional payment will be made following a surgical procedure






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






3. Codes used by insurance compaines to explain actions taken on a Remittance Notice






4. A report to track claim status of patient accounts and to identify individual accounts requiring additional workup for payments or write-offs






5. 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






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






7. 1. Blocks 1-13=patient info 2.Blocks 14-33=physicians info






8. Promote interest and well being of the patients and residents of healthcare facility






9. Specific time frames assigned to a code by an insurance comapny before additional payment will be made following a surgical procedure






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






11. When two companies work together to decided payment of benefits






12. 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






13. 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






14. Authorization by a policyholder to allow a thrid-party payer to pay benefits to a health care provider






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






16. Once claim is approved for payment Remittance Advice(RA) is sent to the provider and EOB is mailed to the policyholder






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






18. A report to track claim status of patient accounts and to identify individual accounts requiring additional workup for payments or write-offs






19. Procedure or services provided without proper authorizationor was not covered by a current authorization -denied - provider can't bill patient for charges






20. Early and Periodic Screenings - Diagnosis - and Treatment






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






22. Percent of payment held back for a risk account in the HMO program






23. Percent of payment held back for a risk account in the HMO program






24. Listing service in their order of importance by dates of service and values. Highest charge to lowest charge






25. Conditions - situations - and services not covered by the insurance carrier






26. Once claim is approved for payment Remittance Advice(RA) is sent to the provider and EOB is mailed to the policyholder






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






28. 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






29. 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






30. Amount charged by a practice when providing services






31. Discount or fee exception given to a patient at the discretion of the physician






32. 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






33. Process or tansferring account information from a journal to a ledger






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






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






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






37. Deferred or delayed processing method for inputting data a retrieval at a later date






38. Federal Employees' Compensation Act






39. Deferred or delayed processing method for inputting data a retrieval at a later date






40. Amount of time allowed by an insurance company for a claim to be submitted for a payment from the date of service






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






42. Amount of time allowed by an insurance company for a claim to be submitted for a payment from the date of service






43. 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






44. Amount required by an insurance company that must be taken off a patient's acoount based on actual agreements and participation






45. Reimbursement directly sent from payer to provider






46. When two companies work together to decided payment of benefits






47. Term for processing payment






48. Listing of diagnosis - procedures - and charges for a patients visit






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






50. Statement of a patient's account history - showing DOS - detailed chrages - payments - day insurance claims was submitted - applicable adjusments - and account balances