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. Organization that accredits clearinghouses






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






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






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






5. The provider receives reimbursement directly from the payer.






6. 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






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






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






9. 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.






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






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






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






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






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






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






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






17. 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.






18. Form used to report institutional - facility services.






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






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






21. Theperson eligible to receive healthcare benefits.






22. 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






23. Medical report substantiating a medical condition






24. 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






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






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






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






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






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






30. Person responsible for paying healthcare fees






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






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






33. 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.






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






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






36. Contract out






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






38. 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.






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






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






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






42. Computer to computer data exchange between payer and provider






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






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






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






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






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






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






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






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