Test your basic knowledge |

Health Insurance

Subject : industries
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. Remittance advice that is submitted to the provider electronically and contains the same information as a paper-based remittance advice; providers receive ERA more quickly.






2. The term hospitals use to describe the encounter form.






3. A claim that is usually more than 120 days past due; some practices establish time frames that are less than 120 days.






4. Advances through various aging periods( 30 -60 -90 -120) with practices typically focusing internal recovery efforts on older delinquent accounts.






5. The maximum amount a payer will reimburse for each procedure or service - according to the patient's policy.






6. Are organized by year; generated for providers who do not accept assignment; includes all unassigned claims for which the provider is not obligated to perform any follow-up work.






7. Specifies what a collection source may or may not do when pursuing payment on past due accounts.






8. Protects information collected by consumers reporting agencies such as credit bureaus - medical information companies and tenant screening services; organizations that provide information to consumer reporting agencies also have specific legal obliga






9. One that has not been paid within a certain time frame; also called delinquent account






10. A check made out to the patient and the provider.






11. Submitted to the payer - but processing is not complete






12. Theperson eligible to receive healthcare benefits.






13. Provision in group health insurance policies that prevents multiple insurers from paying benefits covered by other policies: also specifies that coverage will be provided in a specified sequence when more than one policy covers the claim.






14. Assigning lower-level codes then documented in the record.






15. Organization that accredits clearinghouses






16. Prohibits discrimination on the basis of race - color - religion - national origin - sex - martial status - age - reciept of public assistance - or good faith exercise of any rights under the Cunsumer Credit protection ACT.






17. Does not contract with the insurance plan; patient who elects to recieve care from nonPARS will incur higher out-of-pocket expenses.






18. System by which payers deposit funds to the providers account electronically.






19. Sorting claims upon submission to collect and verify information about a patient and provider.






20. Remittance advice submitted by Medicare to providers that includes payment information about a claim.






21. A routing slip - charge slip - encounter form - or suberbill from which the insurance claim was generated.






22. Legal action to recover a debt; usually a last resort for a medical practice.






23. Health plans - healthcare clearinghouses - government health plans - and any health providers that choose to submit or receive transactions electronically.






24. Claims for which all processing - including appeals - has been completed.






25. Also called a day sheet - a chronological summary of all transactions posted to individual patient ledgers/accounts on a specific day.






26. Established by health insurance companies for a health insurance plan; usually has limits of $1000 or $2000; when the patient has reached the limit of an out-of-pocket payment (deductable) for the year - appropriate patient reimbursement to the provi






27. The percentage the patient pays for covered services after the deductible has been met and the copayment has been paid.






28. A computerized permanent record of all financial transactions between the patient and the pratice - also called patient ledger.






29. Is a public or private entity that processes of facilitates the processing of nonstandard data elements into standard data elements.






30. The provider receives reimbursement directly from the payer.






31. A computerized permanent record of all financial transactions between the patient and the practice;also called patient account record.






32. The transmission of claims data (electronical or manually) to payers or clearinghouses for processing.






33. Clearinghouses that involves value-added vedors - such as banks - in the processing of claims; using a VAN is more efficient and less expensive for providers than managing their own systems to send and receive transactions directly from nummerous ent






34. Amount for which the patient is financially responsible before an insurance company provides coverage.






35. Submitting multiple CPT codes when one code could of been submitted.






36. Accounts receivable that cannot be collected by the provider or a collect agency.






37. Amended the Truth in Lending Act - requiring credit and charge card issuers to provide certain disclosures in direct mail - telephone - and any other application and solicitations for open-end credit and charge accounts and under other circumstances;






38. Determines coverage by primary and secondary policies when each parent subscribes to a different health insurance plan.






39. Comparing a claim to payer edits and the patient's health plan benefits to verify that the required information is available to process the claim; the claim is not a duplicated; payer rules and procedures have been followed; and procedures performed






40. Uses a variable-length file format to process transactions for institutional - professional - dental - and drug claims.






41. A correctly completed standardized claim






42. Shows the status (by date) of outstanding claims from each payer - as well as payments due from patients






43. Medical report substantiating a medical condition






44. Term used for the encounter form in the physicians's office.






45. Any procedure or service reported on a claim that is not included on the payers master benefit list - resulting in denial of the claim; also called noncovered procedure or uncoverd benefit.






46. Associated with how an insurance plan is billed-the insurance plan responsible for paying healthcare insurance claims first is considered primary.






47. Is a past due account; one that has not been paid within a certain time frame.






48. When the provider agrees to accept what the insurance company allows or aproves as payment in full for the claim






49. Person responsible for paying healthcare fees






50. Series of fixed length records submitted to payers to bill for health care services.







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