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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. A correctly completed standardized claim






2. 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.






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






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;






5. The insurance claim form used to report professional services






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






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






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






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






10. 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.






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






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






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






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






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






16. 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






17. Medical report substantiating a medical condition






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






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






20. 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.






21. 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






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






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






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






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






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






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






28. 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.






29. Person responsible for paying healthcare fees






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






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






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






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. The term hospitals use to describe the encounter form.






35. Contract out






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






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






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






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






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






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






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






43. Form used to report institutional - facility services.






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






45. Computer to computer data exchange between payer and provider






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






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






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






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







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