FUNDAMENTS OF MEDICAL BILLING May 6, 2019 admin Leave a comment Fundamentals Of Medical Billing TEST Name 1. What is DME? A. Durable Mechanical Equipment B. Durable Medical Equipment C. Dual Medical Equipment 2. Who will pay the DME items? A. Government or Private Health Insurances B. Parents C. Care Managers 3. What is Medicare and Medicaid? A. Is the United States Legislation that provides data privacy and security provisions for safeguarding medical information. B. These are health plans funded by the US government especially designed for the elderly, disabled poor and the young. C. A and B 4. These are the following examples of DME. A. Adult Nutrition Products B. Food Supplements, Vitamins ETC., C.Traction Equipment, Incontinence Supplies and Wound Care Products 5. Medical Billing is a process that involves health care providers submission and follow up on claims with health ins in order to get payment for services rendered. A. False B. True 6. Payer in Medical Billing. A. Primary( pvt insurance or HMO) Secondary( Medicare)Tertiary( Medicaid) B. Patient, Payer, Provider C. Public, Private, Partners 7. It is a legal process where we request the insurance company to review it's adverse benefit determination with patient's claim for benefits or you are appealing a provider contract issue. A. Federal Partnership B. Electronic Data Interchange C. Medical Billing Appeal 8. Difference between Rejected and Denied Claims. A. Rejected claims send a large number of claims. Denied claims send small numbers of claims. B. Rejected claims a claim rejected because of errors, incorrect input of patient & insurance info. Denied claims claims that has been determined by an insurance company to be unpayable, lacks information.,can also be denied due to coverage limitation. C. Rejected claims is the procedure before discounts are applied. Denied is the procedure after discounts are applied. 9. Prior Authorization is the process of getting an agreement from the payer to cover specific services before the service is performed. A. True B. False 10. Which of the following is the FUNCTION OF CLEARING HOUSE? A. Check the claims errors before submission to the payer B. Follow up claims C. Medical coding 11. What are 3P's in Medical Billing? A. Preserve, Prevent, Promote B. Professional, People, Pioneering C. Patient, Payer, Provider 12. A Clean Claim is a claim that has been suspended in order to get more information from the provider. A. True B. False 13. Coordination Of Benefits - is a process whereby 2 or more insurance companies share the responsibility for payment of a claim for health care services provided to a client. A. True B. False 14. Explanation of Benefits - sent to the patient and the provider to show how the claim is processed. A. True B. False Time is Up!