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






2. 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.






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






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






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






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






7. Medical report substantiating a medical condition






8. Person responsible for paying healthcare fees






9. A correctly completed standardized claim






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






11. 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;






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






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






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






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






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






17. Theperson eligible to receive healthcare benefits.






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






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






20. 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.






21. The provider receives reimbursement directly from the payer.






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






23. The insurance claim form used to report professional services






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






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






26. 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






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






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






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






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






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






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






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






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






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






36. 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.






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






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






39. 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.






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






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






42. Contract out






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






44. 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






45. Organization that accredits clearinghouses






46. 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






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






48. Computer to computer data exchange between payer and provider






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






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