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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. Claims for which all processing - including appeals - has been completed.
Consumer Credit Protection Act of 1968
Closed claim
Primary insurance
Assignment of benefits
2. Is a past due account; one that has not been paid within a certain time frame.
Manual daily accounts receivable journal
Two-party check
Delinquent account
Accounts receivable management
3. A computerized permanent record of all financial transactions between the patient and the pratice - also called patient ledger.
Open claim
Superbill
Patient account record
Fair Credit and Charge Card Disclosure ACT
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;
Accept assignment
Covered entity
Fair Credit Billing Act
Bad debt
5. The insurance claim form used to report professional services
CMS-1500
Unbundling
Past-due account
Coordination of benefits (COB)
6. Series of fixed length records submitted to payers to bill for health care services.
Accounts receivable
Electronic media claim
Encounter form
Fair debt collection practicies Act
7. Contract out
Common data file
Outsourcing
Claims attachment
Patient account record
8. A check made out to the patient and the provider.
Accounts receivable management
Coinsurance
Claims attachment
Two-party check
9. System by which payers deposit funds to the providers account electronically.
Claims submission
Primary insurance
Source document
Electronic funds transfer
10. Person responsible for paying healthcare fees
Guarantor
Day sheet
Claims attachment
Electronic funds transfer
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.
Encounter form
Unassigned claim
Unbundling
Fair credit reporting Act
12. Term used for the encounter form in the physicians's office.
Superbill
Two-party check
Claims attachment
Fair Credit Billing Act
13. Legal action to recover a debt; usually a last resort for a medical practice.
Clean claim
Litigation
CMS-1500
Patient ledger
14. The term hospitals use to describe the encounter form.
Beneficiary
Chargemaster
Electronic Healthcare Network Accreditation Commission EHNAC
Provider Remittance Notice
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
Fair credit reporting Act
Chargemaster
Electronic media claim
Downcoding
16. Uses a variable-length file format to process transactions for institutional - professional - dental - and drug claims.
Two-party check
ANSI ASC X12 standards
Clean claim
Fair debt collection practicies Act
17. Health plans - healthcare clearinghouses - government health plans - and any health providers that choose to submit or receive transactions electronically.
Bad debt
Superbill
Covered entity
Unbundling
18. Determines coverage by primary and secondary policies when each parent subscribes to a different health insurance plan.
Patient ledger
Birthday rule
Unauthorized service
Past-due account
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;
Bad debt
Fair Credit and Charge Card Disclosure ACT
Patient ledger
Encounter form
20. Assists providers in the collection of appropriate reimbursement for services rendered; includes functions such as insurance verfication/eligibility and preauthorization of services
Litigation
Birthday rule
Accounts receivable management
Encounter form
21. Also called a day sheet - a chronological summary of all transactions posted to individual patient ledgers/accounts on a specific day.
Electronic claim processing
Electronic remittance advi
Delinquent claim cycle
Manual daily accounts receivable journal
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.
Manual daily accounts receivable journal
Unassigned claim
Electronic flat file format
Electronic remittance advi
23. Abstract of all recent claims filed on each patient.
Past-due account
Delinquent account
Common data file
Allowed charges
24. When the provider agrees to accept what the insurance company allows or aproves as payment in full for the claim
Open claim
Birthday rule
Electronic funds transfer
Accept assignment
25. A claim that is usually more than 120 days past due; some practices establish time frames that are less than 120 days.
Accounts receivable aging report
Claims attachment
Electronic media claim
Deliquent claim
26. Organization that accredits clearinghouses
Electronic Healthcare Network Accreditation Commission EHNAC
Electronic remittance advi
Birthday rule
Litigation
27. Theperson eligible to receive healthcare benefits.
Claims submission
Accept assignment
Deliquent claim
Beneficiary
28. Shows the status (by date) of outstanding claims from each payer - as well as payments due from patients
Accounts receivable aging report
Encounter form
Deliquent claim
Superbill
29. Computer to computer data exchange between payer and provider
Beneficiary
Coinsurance
Fair credit reporting Act
Electronic data interchange EDI
30. Assigning lower-level codes then documented in the record.
Deductible
Downcoding
Day sheet
Claims submission
31. Form used to report institutional - facility services.
Day sheet
Past-due account
UB-04
Accounts receivable management
32. A computerized permanent record of all financial transactions between the patient and the practice;also called patient account record.
Covered entity
Claims attachment
Patient ledger
Allowed charges
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
Equal Credit Opportunity ACT
Electronic funds transfer
Out-of-pocket payment
Unbundling
34. Specifies what a collection source may or may not do when pursuing payment on past due accounts.
Fair debt collection practicies Act
Out-of-pocket payment
Assignment of benefits
Superbill
35. Advances through various aging periods( 30 -60 -90 -120) with practices typically focusing internal recovery efforts on older delinquent accounts.
Unassigned claim
Value-added network (VAN)
Provider Remittance Notice
Delinquent claim cycle
36. Accounts receivable that cannot be collected by the provider or a collect agency.
Open claim
Clearinghouse
Bad debt
Fair credit reporting Act
37. The percentage the patient pays for covered services after the deductible has been met and the copayment has been paid.
Fair Credit and Charge Card Disclosure ACT
Coinsurance
Participating provider
Manual daily accounts receivable journal
38. Establishes the rights. liabilites - and rsponsibilities of participants in electronic funds transfer systems.
Provider Remittance Notice
Electronic funds transfer ACT
Coinsurance
Fair debt collection practicies Act
39. Medical report substantiating a medical condition
Claims attachment
Manual daily accounts receivable journal
Pre-existing condition
Fair Credit Billing Act
40. Services that are provided to a patient without proper authorization or that are not covered by a current authorization.
Coordination of benefits (COB)
Electronic data interchange EDI
Unauthorized service
Two-party check
41. One that has not been paid within a certain time frame; also called delinquent account
Fair debt collection practicies Act
Chargemaster
Past-due account
Delinquent account
42. The maximum amount a payer will reimburse for each procedure or service - according to the patient's policy.
Clean claim
Clearinghouse
Allowed charges
Value-added network (VAN)
43. Amount for which the patient is financially responsible before an insurance company provides coverage.
Accounts receivable
Deductible
UB-04
Accounts receivable aging report
44. Series of fixed length records submitted to payers to bill for health care services.
Electronic data interchange EDI
Electronic flat file format
Guarantor
Clearinghouse
45. Remittance advice submitted by Medicare to providers that includes payment information about a claim.
Closed claim
Provider Remittance Notice
Two-party check
Encounter form
46. Also called manual daily accounts receivable journal; cronological summary of all transactions posted to individual patient legers/accounts on a specific day.
Day sheet
Electronic data interchange EDI
UB-04
Electronic funds transfer ACT
47. Does not contract with the insurance plan; patient who elects to recieve care from nonPARS will incur higher out-of-pocket expenses.
Accept assignment
Claims adjudication
Claims attachment
Nonparticipating provider
48. Submitted to the payer - but processing is not complete
Claims attachment
Accounts receivable
Accounts receivable management
Open claim
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.
Delinquent account
Patient ledger
UB-04
Equal Credit Opportunity ACT
50. Sorting claims upon submission to collect and verify information about a patient and provider.
Out-of-pocket payment
Claims processing
Electronic data interchange EDI
Accounts receivable management