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






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






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. Submitting multiple CPT codes when one code could of been submitted.






5. A correctly completed standardized claim






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






7. Organization that accredits clearinghouses






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






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






10. 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






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






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






13. 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.






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






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






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






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






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






19. Term used for the encounter form in the physicians's office.






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






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






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






23. Contract out






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






25. 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






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






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






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






29. 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






30. The insurance claim form used to report professional services






31. 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






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






33. 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






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






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






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






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






38. Theperson eligible to receive healthcare benefits.






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






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






41. 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.






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






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






44. Person responsible for paying healthcare fees






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






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






47. 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;






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






49. 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.






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