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






3. 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;






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






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






6. The insurance claim form used to report professional services






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






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






9. 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






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






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






12. 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






13. 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;






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






15. 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.






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






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






18. Medical report substantiating a medical condition






19. Form used to report institutional - facility services.






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






21. Organization that accredits clearinghouses






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






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






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






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






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






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






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






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






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






31. 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






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






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






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






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






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






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






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






39. Contract out






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






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






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






44. A correctly completed standardized claim






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






46. Person responsible for paying healthcare fees






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






48. 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






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






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







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