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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. Theperson eligible to receive healthcare benefits.
Consumer Credit Protection Act of 1968
UB-04
Beneficiary
Manual daily accounts receivable journal
2. A correctly completed standardized claim
Manual daily accounts receivable journal
Beneficiary
Clean claim
ANSI ASC X12 standards
3. Also called manual daily accounts receivable journal; cronological summary of all transactions posted to individual patient legers/accounts on a specific day.
Day sheet
Superbill
Fair Credit and Charge Card Disclosure ACT
Birthday rule
4. A routing slip - charge slip - encounter form - or suberbill from which the insurance claim was generated.
Source document
UB-04
Electronic flat file format
Allowed charges
5. Associated with how an insurance plan is billed-the insurance plan responsible for paying healthcare insurance claims first is considered primary.
Claims attachment
Birthday rule
Primary insurance
Accounts receivable management
6. When the provider agrees to accept what the insurance company allows or aproves as payment in full for the claim
Value-added network (VAN)
Common data file
Accept assignment
CMS-1500
7. Contract out
Claims attachment
Patient account record
Outsourcing
Electronic funds transfer
8. Person responsible for paying healthcare fees
Electronic claim processing
Guarantor
Electronic media claim
Unbundling
9. The term hospitals use to describe the encounter form.
Electronic flat file format
Chargemaster
Accept assignment
Participating provider
10. Legal action to recover a debt; usually a last resort for a medical practice.
Superbill
Covered entity
Litigation
Unassigned claim
11. Services that are provided to a patient without proper authorization or that are not covered by a current authorization.
Clean claim
Allowed charges
Nonparticipating provider
Unauthorized service
12. Series of fixed length records submitted to payers to bill for health care services.
Guarantor
Electronic claim processing
Nonparticipating provider
Electronic flat file format
13. System by which payers deposit funds to the providers account electronically.
Electronic funds transfer
Fair debt collection practicies Act
Outsourcing
Provider Remittance Notice
14. A computerized permanent record of all financial transactions between the patient and the practice;also called patient account record.
Patient ledger
Accounts receivable aging report
Covered entity
Provider Remittance Notice
15. 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
Day sheet
Beneficiary
Accounts receivable
Out-of-pocket payment
16. Amount for which the patient is financially responsible before an insurance company provides coverage.
Out-of-pocket payment
Litigation
Beneficiary
Deductible
17. 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
Assignment of benefits
Clearinghouse
Fair credit reporting Act
Electronic data interchange EDI
18. 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
Pre-existing condition
Deductible
Claims adjudication
Provider Remittance Notice
19. Establishes the rights. liabilites - and rsponsibilities of participants in electronic funds transfer systems.
Noncovered benefit
Beneficiary
Patient ledger
Electronic funds transfer ACT
20. Accounts receivable that cannot be collected by the provider or a collect agency.
Claims submission
Beneficiary
Bad debt
Fair debt collection practicies Act
21. Claims for which all processing - including appeals - has been completed.
Past-due account
Closed claim
Delinquent account
Electronic Healthcare Network Accreditation Commission EHNAC
22. Advances through various aging periods( 30 -60 -90 -120) with practices typically focusing internal recovery efforts on older delinquent accounts.
Delinquent claim cycle
Accounts receivable aging report
Guarantor
Unassigned claim
23. Also called a day sheet - a chronological summary of all transactions posted to individual patient ledgers/accounts on a specific day.
Manual daily accounts receivable journal
Coinsurance
Electronic Healthcare Network Accreditation Commission EHNAC
Consumer Credit Protection Act of 1968
24. A check made out to the patient and the provider.
Unbundling
Equal Credit Opportunity ACT
Two-party check
Patient account record
25. Sending data in a standardized machine readable format to an insurance company via disk - telephone or cable.
Electronic media claim
Electronic claim processing
Electronic funds transfer ACT
Accept assignment
26. The amount owed to a business for services or goods provided
Clean claim
Accounts receivable
Claims adjudication
Allowed charges
27. Term used for the encounter form in the physicians's office.
Superbill
Accounts receivable aging report
Accounts receivable
Source document
28. Assigning lower-level codes then documented in the record.
Downcoding
Bad debt
Electronic funds transfer ACT
Accounts receivable aging report
29. The maximum amount a payer will reimburse for each procedure or service - according to the patient's policy.
Bad debt
Electronic flat file format
Chargemaster
Allowed charges
30. 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
Past-due account
Common data file
Claims processing
31. The insurance claim form used to report professional services
Fair Credit and Charge Card Disclosure ACT
Two-party check
CMS-1500
Accounts receivable aging report
32. 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.
Equal Credit Opportunity ACT
Electronic funds transfer
Deliquent claim
Beneficiary
33. 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.
Coinsurance
Unauthorized service
Unassigned claim
Manual daily accounts receivable journal
34. Assists providers in the collection of appropriate reimbursement for services rendered; includes functions such as insurance verfication/eligibility and preauthorization of services
Unassigned claim
Nonparticipating provider
Accounts receivable management
Participating provider
35. Submitting multiple CPT codes when one code could of been submitted.
Outsourcing
Closed claim
Fair Credit and Charge Card Disclosure ACT
Unbundling
36. 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.
Electronic remittance advi
Electronic Healthcare Network Accreditation Commission EHNAC
Closed claim
Delinquent claim cycle
37. Determines coverage by primary and secondary policies when each parent subscribes to a different health insurance plan.
Two-party check
Unassigned claim
Assignment of benefits
Birthday rule
38. Is a public or private entity that processes of facilitates the processing of nonstandard data elements into standard data elements.
Open claim
Clearinghouse
Accounts receivable aging report
Primary insurance
39. 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;
Electronic funds transfer ACT
Claims attachment
Fair Credit Billing Act
Nonparticipating provider
40. Is a past due account; one that has not been paid within a certain time frame.
Accounts receivable management
Delinquent account
CMS-1500
Superbill
41. A claim that is usually more than 120 days past due; some practices establish time frames that are less than 120 days.
Birthday rule
Deliquent claim
Litigation
Consumer Credit Protection Act of 1968
42. 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.
Coordination of benefits (COB)
Bad debt
Provider Remittance Notice
Accounts receivable aging report
43. Remittance advice submitted by Medicare to providers that includes payment information about a claim.
Provider Remittance Notice
Consumer Credit Protection Act of 1968
Participating provider
Fair credit reporting Act
44. Medical report substantiating a medical condition
Downcoding
Claims attachment
Patient ledger
CMS-1500
45. The provider receives reimbursement directly from the payer.
Consumer Credit Protection Act of 1968
Fair credit reporting Act
Litigation
Assignment of benefits
46. Shows the status (by date) of outstanding claims from each payer - as well as payments due from patients
Value-added network (VAN)
Day sheet
Fair debt collection practicies Act
Accounts receivable aging report
47. 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
Litigation
Value-added network (VAN)
Patient account record
Covered entity
48. Does not contract with the insurance plan; patient who elects to recieve care from nonPARS will incur higher out-of-pocket expenses.
Nonparticipating provider
Birthday rule
Consumer Credit Protection Act of 1968
Accounts receivable aging report
49. Organization that accredits clearinghouses
Chargemaster
Electronic Healthcare Network Accreditation Commission EHNAC
ANSI ASC X12 standards
Electronic remittance advi
50. 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
Downcoding
Noncovered benefit
Consumer Credit Protection Act of 1968
Value-added network (VAN)