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. Form used to report institutional - facility services.






2. 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






3. The insurance claim form used to report professional services






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. Contract out






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






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






8. 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






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






10. 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;






11. Computer to computer data exchange between payer and provider






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






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






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






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






16. 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






17. 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






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






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






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






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






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






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






24. 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






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






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






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






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






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






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






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






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






33. Medical report substantiating a medical condition






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






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






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






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






38. 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.






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






40. 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.






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






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






43. Organization that accredits clearinghouses






44. Person responsible for paying healthcare fees






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






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






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






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






49. 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.






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