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. The term hospitals use to describe the encounter form.






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






3. A correctly completed standardized claim






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






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






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






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






8. Abstract of all recent claims filed on each patient.






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






10. Medical report substantiating a medical condition






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






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






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






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






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






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






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






18. 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.






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






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






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






22. The provider receives reimbursement directly from the payer.






23. 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.






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






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






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






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






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






29. Person responsible for paying healthcare fees






30. 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






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






32. Organization that accredits clearinghouses






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






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






35. The insurance claim form used to report professional services






36. 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.






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






38. 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.






39. Theperson eligible to receive healthcare benefits.






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






41. Computer to computer data exchange between payer and provider






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






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






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






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






46. 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;






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






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






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






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