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. 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.






2. Contracts with a helath insurance plan and accepts whatever the plan pays for procedures or services performed.






3. Sending data in a standardized machine readable format to an insurance company via disk - telephone or cable.






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






5. 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.






6. Organization that accredits clearinghouses






7. The amount owed to a business for services or goods provided






8. Theperson eligible to receive healthcare benefits.






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






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






11. 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






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






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






14. Federal law passed in 1975 that helps consumers resolve billing issues with card issuers; protects important credit rights - including rights to dispute billing errors - unauthorized use of account - and charges for unsatisfactory goods and services;






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






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. Financial record source document used by providers and other personnel to record treated diagnoses and services rendered to the patient during the current encounter.






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






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






20. Assists providers in the collection of appropriate reimbursement for services rendered; includes functions such as insurance verfication/eligibility and preauthorization of services






21. Also called manual daily accounts receivable journal; cronological summary of all transactions posted to individual patient legers/accounts on a specific day.






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






23. 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






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






25. The landmark legislation because it launched truth in lending disclosures that reguired creditors to communicate the cost of borrrowing money in a common language so that consumers could figure out the charges - compare cost - and shop for the best c






26. 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.






27. Computer to computer data exchange between payer and provider






28. 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;






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






30. Contract out






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






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






33. Form used to report institutional - facility services.






34. Establishes the rights. liabilites - and rsponsibilities of participants in electronic funds transfer systems.






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






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






37. The provider receives reimbursement directly from the payer.






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






39. A correctly completed standardized claim






40. Person responsible for paying healthcare fees






41. 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






42. Any medical condition that was diagnosed and or treated within a specified period of time immediately preceding the enrollee's effective date of coverage.






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






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






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






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






47. Services that are provided to a patient without proper authorization or that are not covered by a current authorization.






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






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






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







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