Test your basic knowledge |

Health Insurance

Subject : industries
  • Answer 50 questions in 15 minutes.
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  • 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. Submitting multiple CPT codes when one code could of been submitted.

2. 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;

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

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

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

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

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

9. Person responsible for paying healthcare fees

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

11. 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

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

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

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

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

18. The provider receives reimbursement directly from the payer.

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

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

21. A correctly completed standardized claim

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

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

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

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

26. Computer to computer data exchange between payer and provider

27. 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.

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

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

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

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

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

33. 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;

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

35. 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.

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

37. 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

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

39. Form used to report institutional - facility services.

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

41. 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

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

43. The insurance claim form used to report professional services

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

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

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

47. Medical report substantiating a medical condition

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

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

50. Organization that accredits clearinghouses