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 correctly completed standardized claim






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






3. 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






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






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






6. Form used to report institutional - facility services.






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






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






9. The insurance claim form used to report professional services






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






11. 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






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






13. Computer to computer data exchange between payer and provider






14. 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;






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






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






17. Theperson eligible to receive healthcare benefits.






18. Person responsible for paying healthcare fees






19. The provider receives reimbursement directly from the payer.






20. 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.






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






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






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






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






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






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






27. 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.






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






29. 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






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






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






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






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






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






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






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






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






39. Organization that accredits clearinghouses






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






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






42. 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






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






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






45. Medical report substantiating a medical condition






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






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






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