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






2. 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






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






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






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






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






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






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






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






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






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






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






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






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






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






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






17. Contract out






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






19. Theperson eligible to receive healthcare benefits.






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






21. The insurance claim form used to report professional services






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






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






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






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






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






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






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






29. 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;






30. 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






31. 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






32. Organization that accredits clearinghouses






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






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






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






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. Person responsible for paying healthcare fees






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






39. 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.






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






41. 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;






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






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






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






45. 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.






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






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






48. Medical report substantiating a medical condition






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






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