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






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






3. 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.






4. 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.






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






6. Person responsible for paying healthcare fees






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






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






9. The provider receives reimbursement directly from the payer.






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. 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






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






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






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






15. 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.






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






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






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






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






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






21. Form used to report institutional - facility services.






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






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






24. The insurance claim form used to report professional services






25. Contract out






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






27. Computer to computer data exchange between payer and provider






28. 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.






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






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






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






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






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






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






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






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






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






38. Organization that accredits clearinghouses






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






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






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






42. 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;






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






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






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






46. 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






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






48. 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






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






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