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Test your basic knowledge |
Health Insurance
Start Test
Study First
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. Theperson eligible to receive healthcare benefits.
Source document
Clean claim
Beneficiary
Deliquent claim
2. Medical report substantiating a medical condition
Open claim
Participating provider
Claims attachment
Patient account record
3. The maximum amount a payer will reimburse for each procedure or service - according to the patient's policy.
Electronic funds transfer
Primary insurance
Allowed charges
Delinquent account
4. Sending data in a standardized machine readable format to an insurance company via disk - telephone or cable.
Deliquent claim
Superbill
Coinsurance
Electronic claim processing
5. The amount owed to a business for services or goods provided
Accounts receivable
Noncovered benefit
Accept assignment
Downcoding
6. The percentage the patient pays for covered services after the deductible has been met and the copayment has been paid.
Value-added network (VAN)
Coinsurance
Assignment of benefits
Delinquent claim cycle
7. 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.
Source document
Electronic data interchange EDI
Allowed charges
Equal Credit Opportunity ACT
8. Person responsible for paying healthcare fees
Electronic data interchange EDI
Outsourcing
Unbundling
Guarantor
9. Accounts receivable that cannot be collected by the provider or a collect agency.
Fair Credit Billing Act
Past-due account
Unassigned claim
Bad debt
10. 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.
Fair Credit and Charge Card Disclosure ACT
Electronic claim processing
Delinquent claim cycle
Noncovered benefit
11. Health plans - healthcare clearinghouses - government health plans - and any health providers that choose to submit or receive transactions electronically.
Allowed charges
Open claim
Accounts receivable management
Covered entity
12. A routing slip - charge slip - encounter form - or suberbill from which the insurance claim was generated.
Source document
Patient account record
Common data file
Claims adjudication
13. 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
Accept assignment
Equal Credit Opportunity ACT
Claims adjudication
Deductible
14. A correctly completed standardized claim
Two-party check
Fair Credit and Charge Card Disclosure ACT
Clean claim
Encounter form
15. One that has not been paid within a certain time frame; also called delinquent account
Electronic funds transfer
Downcoding
Past-due account
Out-of-pocket payment
16. Legal action to recover a debt; usually a last resort for a medical practice.
Coordination of benefits (COB)
CMS-1500
Electronic funds transfer
Litigation
17. Any medical condition that was diagnosed and or treated within a specified period of time immediately preceding the enrollee's effective date of coverage.
Bad debt
Delinquent claim cycle
Day sheet
Pre-existing condition
18. Series of fixed length records submitted to payers to bill for health care services.
Past-due account
Electronic flat file format
Fair debt collection practicies Act
Allowed charges
19. 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
Encounter form
Fair credit reporting Act
Past-due account
Claims adjudication
20. Submitting multiple CPT codes when one code could of been submitted.
Unbundling
Two-party check
Delinquent claim cycle
Nonparticipating provider
21. Amount for which the patient is financially responsible before an insurance company provides coverage.
Nonparticipating provider
Deductible
Accounts receivable aging report
Electronic claim processing
22. 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
Closed claim
Past-due account
Out-of-pocket payment
Provider Remittance Notice
23. 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;
Fair Credit and Charge Card Disclosure ACT
Deliquent claim
Delinquent claim cycle
Open claim
24. Claims for which all processing - including appeals - has been completed.
Electronic funds transfer
Deliquent claim
Provider Remittance Notice
Closed claim
25. Organization that accredits clearinghouses
Covered entity
Electronic Healthcare Network Accreditation Commission EHNAC
Closed claim
Coordination of benefits (COB)
26. The insurance claim form used to report professional services
CMS-1500
Accounts receivable management
Accounts receivable
Allowed charges
27. Contracts with a helath insurance plan and accepts whatever the plan pays for procedures or services performed.
Clearinghouse
Day sheet
Participating provider
Patient ledger
28. 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
Unassigned claim
Value-added network (VAN)
Clean claim
Patient ledger
29. Remittance advice submitted by Medicare to providers that includes payment information about a claim.
Provider Remittance Notice
Electronic flat file format
Accept assignment
Fair Credit Billing Act
30. Financial record source document used by providers and other personnel to record treated diagnoses and services rendered to the patient during the current encounter.
Pre-existing condition
Beneficiary
Encounter form
Participating provider
31. Shows the status (by date) of outstanding claims from each payer - as well as payments due from patients
Accounts receivable aging report
Two-party check
Day sheet
Guarantor
32. Submitted to the payer - but processing is not complete
Open claim
Unauthorized service
Electronic funds transfer ACT
Chargemaster
33. Abstract of all recent claims filed on each patient.
Common data file
Electronic funds transfer ACT
Delinquent account
Equal Credit Opportunity ACT
34. Term used for the encounter form in the physicians's office.
Superbill
Claims attachment
Primary insurance
Delinquent claim cycle
35. 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.
Unassigned claim
Beneficiary
Coordination of benefits (COB)
Delinquent account
36. Also called a day sheet - a chronological summary of all transactions posted to individual patient ledgers/accounts on a specific day.
Manual daily accounts receivable journal
Electronic Healthcare Network Accreditation Commission EHNAC
Two-party check
Downcoding
37. Services that are provided to a patient without proper authorization or that are not covered by a current authorization.
Fair credit reporting Act
Common data file
Guarantor
Unauthorized service
38. Establishes the rights. liabilites - and rsponsibilities of participants in electronic funds transfer systems.
Electronic media claim
Claims attachment
Electronic funds transfer ACT
Pre-existing condition
39. Associated with how an insurance plan is billed-the insurance plan responsible for paying healthcare insurance claims first is considered primary.
Claims attachment
Primary insurance
Accounts receivable management
Participating provider
40. Sorting claims upon submission to collect and verify information about a patient and provider.
Claims processing
Unauthorized service
Coordination of benefits (COB)
Fair debt collection practicies Act
41. 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.
Provider Remittance Notice
Coordination of benefits (COB)
Manual daily accounts receivable journal
Fair Credit and Charge Card Disclosure ACT
42. Assists providers in the collection of appropriate reimbursement for services rendered; includes functions such as insurance verfication/eligibility and preauthorization of services
Electronic media claim
Accounts receivable management
Deliquent claim
Allowed charges
43. Computer to computer data exchange between payer and provider
Claims processing
Electronic data interchange EDI
Electronic remittance advi
Deliquent claim
44. Also called manual daily accounts receivable journal; cronological summary of all transactions posted to individual patient legers/accounts on a specific day.
Day sheet
Claims adjudication
Pre-existing condition
Litigation
45. A claim that is usually more than 120 days past due; some practices establish time frames that are less than 120 days.
Unauthorized service
Closed claim
ANSI ASC X12 standards
Deliquent claim
46. Assigning lower-level codes then documented in the record.
Downcoding
Unauthorized service
CMS-1500
Birthday rule
47. A computerized permanent record of all financial transactions between the patient and the practice;also called patient account record.
Outsourcing
Clean claim
Patient ledger
Electronic Healthcare Network Accreditation Commission EHNAC
48. Is a public or private entity that processes of facilitates the processing of nonstandard data elements into standard data elements.
Electronic flat file format
Clearinghouse
Participating provider
Fair credit reporting Act
49. Form used to report institutional - facility services.
Electronic remittance advi
Accounts receivable management
UB-04
Electronic funds transfer ACT
50. Specifies what a collection source may or may not do when pursuing payment on past due accounts.
Primary insurance
Out-of-pocket payment
Fair debt collection practicies Act
Claims attachment