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. Term for processing payment






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






3. Assigned to the physician by Medicare program






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






5. Using ICD-9 codes to hughest degree






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






7. Durable Medical Equipment Regional Carrier






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






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






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






11. Established proce set by a medical practice for proefessional services






12. CMS 1500 - became effective July 2007 -All third party payers accept it - Medicare requires all physicians to use it






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






14. 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`






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






16. Passed by the federal government to prosecute cases of Medicaid fraud






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






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






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






20. 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






21. Take what insurance pays






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






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






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






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






26. 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'






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






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






29. 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






30. 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






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






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






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






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






35. Federal Employees' Compensation Act






36. Electronic or paper-based report of payment sent by the payer to the provider






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






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






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






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






41. Relationship between the amount of money owed and the amount of money collected






42. 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






43. 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






44. Superbill or Encounter Form






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






46. Early and Periodic Screenings - Diagnosis - and Treatment






47. Process of converting diagnoses - procedures - and services into numeric and alpha-numeric characters






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






49. Patient who owes a balance on the account who has moved without a forwarding address






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