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. 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






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






3. 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






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






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






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






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






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






10. Organization that accredits clearinghouses






11. A correctly completed standardized claim






12. 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.






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






14. 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.






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






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






17. Person responsible for paying healthcare fees






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






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






20. Form used to report institutional - facility services.






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






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






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






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






25. The insurance claim form used to report professional services






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






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






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






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






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






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






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






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






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






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






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






37. The provider receives reimbursement directly from the payer.






38. Medical report substantiating a medical condition






39. 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.






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






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






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






43. 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






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






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






46. Computer to computer data exchange between payer and provider






47. 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






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






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






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