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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. 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






2. Contract out






3. Computer to computer data exchange between payer and provider






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






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






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






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






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






9. Person responsible for paying healthcare fees






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






11. Form used to report institutional - facility services.






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






13. 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.






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






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






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






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






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






19. Contracts with a helath insurance plan and accepts whatever the plan pays for procedures or services performed.






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. 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.






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






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






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






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






26. 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;






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






28. Theperson eligible to receive healthcare benefits.






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






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






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






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






33. The insurance claim form used to report professional services






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






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






36. A correctly completed standardized claim






37. The provider receives reimbursement directly from the payer.






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






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






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






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






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. Medical report substantiating a medical condition






44. 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






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






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






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






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







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