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






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






3. Form used to report institutional - facility services.






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






5. 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






6. Organization that accredits clearinghouses






7. 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.






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






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






10. A correctly completed standardized claim






11. Contract out






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






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






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






15. Computer to computer data exchange between payer and provider






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






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






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






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






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






21. 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






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






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






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






26. 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.






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






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






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. Abstract of all recent claims filed on each patient.






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






32. The provider receives reimbursement directly from the payer.






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






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






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






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






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






38. 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






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






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






41. 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.






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






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






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






45. 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






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






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






48. Medical report substantiating a medical condition






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






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