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






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






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






4. 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;






5. The insurance claim form used to report professional services






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






7. Contract out






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






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






10. Person responsible for paying healthcare fees






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






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






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






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






15. 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






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






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






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






19. 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;






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






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






22. 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.






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






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






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






26. Organization that accredits clearinghouses






27. Theperson eligible to receive healthcare benefits.






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






29. Computer to computer data exchange between payer and provider






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






31. Form used to report institutional - facility services.






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






33. 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






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






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






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






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






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






39. Medical report substantiating a medical condition






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






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






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






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






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






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






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






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






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






49. 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.






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