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Health Insurance

Subject : industries
Instructions:
  • Answer 50 questions in 15 minutes.
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  • 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. 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;






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






3. 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






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






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






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






7. 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






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






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






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






11. A correctly completed standardized claim






12. Medical report substantiating a medical condition






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






14. The insurance claim form used to report professional services






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






16. Computer to computer data exchange between payer and provider






17. The provider receives reimbursement directly from the payer.






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






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






20. 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.






21. Contract out






22. Person responsible for paying healthcare fees






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






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






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






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






27. Organization that accredits clearinghouses






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






29. 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.






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






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






32. 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






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






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






36. 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






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






38. Form used to report institutional - facility services.






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






40. 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






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






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






43. 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.






44. Theperson eligible to receive healthcare benefits.






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






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






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






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






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






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







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