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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. 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;






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






3. 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






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






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






6. Contract out






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






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






9. 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






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






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






12. Organization that accredits clearinghouses






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






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






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






16. The provider receives reimbursement directly from the payer.






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






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






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






20. Medical report substantiating a medical condition






21. 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.






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






23. 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.






24. 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






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






26. A correctly completed standardized claim






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






28. Form used to report institutional - facility services.






29. 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.






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






31. Person responsible for paying healthcare fees






32. The insurance claim form used to report professional services






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






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






35. 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;






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






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






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






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






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






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






42. 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






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






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






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






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






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






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






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







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