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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. Legal action to recover a debt; usually a last resort for a medical practice.
Primary insurance
Litigation
Electronic funds transfer ACT
Consumer Credit Protection Act of 1968
2. One that has not been paid within a certain time frame; also called delinquent account
Coinsurance
Past-due account
Electronic claim processing
Chargemaster
3. When the provider agrees to accept what the insurance company allows or aproves as payment in full for the claim
Value-added network (VAN)
Unbundling
Unauthorized service
Accept assignment
4. 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.
Fair debt collection practicies Act
Covered entity
Out-of-pocket payment
Equal Credit Opportunity ACT
5. Contract out
Open claim
Clean claim
Outsourcing
Electronic Healthcare Network Accreditation Commission EHNAC
6. Health plans - healthcare clearinghouses - government health plans - and any health providers that choose to submit or receive transactions electronically.
Covered entity
Claims submission
Claims processing
Unauthorized service
7. Form used to report institutional - facility services.
UB-04
Outsourcing
Allowed charges
Fair credit reporting Act
8. Associated with how an insurance plan is billed-the insurance plan responsible for paying healthcare insurance claims first is considered primary.
Coordination of benefits (COB)
Birthday rule
Participating provider
Primary insurance
9. Is a past due account; one that has not been paid within a certain time frame.
Electronic funds transfer ACT
Delinquent account
Electronic data interchange EDI
Deliquent claim
10. Remittance advice submitted by Medicare to providers that includes payment information about a claim.
Fair debt collection practicies Act
Electronic media claim
Claims adjudication
Provider Remittance Notice
11. 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
Consumer Credit Protection Act of 1968
Out-of-pocket payment
Electronic media claim
Delinquent account
12. Also called a day sheet - a chronological summary of all transactions posted to individual patient ledgers/accounts on a specific day.
Unauthorized service
Manual daily accounts receivable journal
Assignment of benefits
Deliquent claim
13. Amount for which the patient is financially responsible before an insurance company provides coverage.
Deductible
Claims attachment
Guarantor
Pre-existing condition
14. A claim that is usually more than 120 days past due; some practices establish time frames that are less than 120 days.
Out-of-pocket payment
Consumer Credit Protection Act of 1968
Participating provider
Deliquent claim
15. Assists providers in the collection of appropriate reimbursement for services rendered; includes functions such as insurance verfication/eligibility and preauthorization of services
Accept assignment
Outsourcing
Value-added network (VAN)
Accounts receivable management
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.
Electronic funds transfer
Encounter form
Bad debt
Consumer Credit Protection Act of 1968
17. 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
ANSI ASC X12 standards
Electronic claim processing
Delinquent account
Claims adjudication
18. System by which payers deposit funds to the providers account electronically.
Electronic funds transfer
Electronic flat file format
Electronic media claim
Out-of-pocket payment
19. Contracts with a helath insurance plan and accepts whatever the plan pays for procedures or services performed.
Participating provider
Source document
Accept assignment
Chargemaster
20. Series of fixed length records submitted to payers to bill for health care services.
Claims attachment
Deductible
Electronic flat file format
Coinsurance
21. The percentage the patient pays for covered services after the deductible has been met and the copayment has been paid.
Electronic remittance advi
Coinsurance
Covered entity
Beneficiary
22. Person responsible for paying healthcare fees
Assignment of benefits
Fair debt collection practicies Act
Guarantor
Electronic data interchange EDI
23. Claims for which all processing - including appeals - has been completed.
Electronic data interchange EDI
Coordination of benefits (COB)
Closed claim
Claims submission
24. 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
Covered entity
Coinsurance
Electronic Healthcare Network Accreditation Commission EHNAC
25. Uses a variable-length file format to process transactions for institutional - professional - dental - and drug claims.
Patient account record
ANSI ASC X12 standards
Electronic media claim
Closed claim
26. The insurance claim form used to report professional services
Closed claim
CMS-1500
Beneficiary
Fair credit reporting Act
27. Organization that accredits clearinghouses
Fair debt collection practicies Act
Electronic Healthcare Network Accreditation Commission EHNAC
Assignment of benefits
Unbundling
28. A computerized permanent record of all financial transactions between the patient and the pratice - also called patient ledger.
Pre-existing condition
Electronic data interchange EDI
Patient account record
UB-04
29. Computer to computer data exchange between payer and provider
Two-party check
Electronic funds transfer ACT
Electronic data interchange EDI
ANSI ASC X12 standards
30. A routing slip - charge slip - encounter form - or suberbill from which the insurance claim was generated.
Delinquent account
Litigation
Source document
Fair credit reporting Act
31. Abstract of all recent claims filed on each patient.
Electronic Healthcare Network Accreditation Commission EHNAC
Patient account record
ANSI ASC X12 standards
Common data file
32. Advances through various aging periods( 30 -60 -90 -120) with practices typically focusing internal recovery efforts on older delinquent accounts.
Delinquent claim cycle
Delinquent account
Patient account record
Unbundling
33. Establishes the rights. liabilites - and rsponsibilities of participants in electronic funds transfer systems.
Electronic funds transfer ACT
Electronic data interchange EDI
Allowed charges
Claims adjudication
34. A check made out to the patient and the provider.
Patient account record
Accounts receivable
Pre-existing condition
Two-party check
35. The amount owed to a business for services or goods provided
Accounts receivable
Claims adjudication
Deductible
Out-of-pocket payment
36. Any medical condition that was diagnosed and or treated within a specified period of time immediately preceding the enrollee's effective date of coverage.
Electronic flat file format
Pre-existing condition
Accounts receivable management
Accounts receivable aging report
37. Services that are provided to a patient without proper authorization or that are not covered by a current authorization.
Noncovered benefit
Unauthorized service
Accounts receivable
ANSI ASC X12 standards
38. Accounts receivable that cannot be collected by the provider or a collect agency.
Fair Credit and Charge Card Disclosure ACT
Birthday rule
Electronic remittance advi
Bad debt
39. Series of fixed length records submitted to payers to bill for health care services.
Consumer Credit Protection Act of 1968
Fair Credit and Charge Card Disclosure ACT
Electronic media claim
Primary insurance
40. Submitted to the payer - but processing is not complete
Patient ledger
Open claim
Fair debt collection practicies Act
Electronic Healthcare Network Accreditation Commission EHNAC
41. The provider receives reimbursement directly from the payer.
Assignment of benefits
Manual daily accounts receivable journal
Electronic remittance advi
Clearinghouse
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.
Delinquent account
Electronic remittance advi
Electronic media claim
Coordination of benefits (COB)
43. Assigning lower-level codes then documented in the record.
Downcoding
Patient ledger
Claims submission
Past-due account
44. Term used for the encounter form in the physicians's office.
Primary insurance
Superbill
Source document
Claims attachment
45. A correctly completed standardized claim
Patient account record
Deliquent claim
Chargemaster
Clean claim
46. 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.
Unassigned claim
Provider Remittance Notice
Accounts receivable aging report
Accounts receivable management
47. 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;
Electronic funds transfer
Fair Credit and Charge Card Disclosure ACT
Unauthorized service
Equal Credit Opportunity ACT
48. 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.
Downcoding
Equal Credit Opportunity ACT
Noncovered benefit
Guarantor
49. Submitting multiple CPT codes when one code could of been submitted.
Pre-existing condition
Unbundling
Electronic remittance advi
Bad debt
50. A computerized permanent record of all financial transactions between the patient and the practice;also called patient account record.
Patient ledger
Value-added network (VAN)
Deliquent claim
Fair Credit Billing Act