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






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






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






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






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






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






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






8. Contract out






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






10. Computer to computer data exchange between payer and provider






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






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






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






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






15. The insurance claim form used to report professional services






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






17. 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






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






19. 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.






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






22. Form used to report institutional - facility services.






23. 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.






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






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






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






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






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






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






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






31. A correctly completed standardized claim






32. The provider receives reimbursement directly from the payer.






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






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






35. 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






36. Theperson eligible to receive healthcare benefits.






37. 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.






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






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






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






41. Medical report substantiating a medical condition






42. 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.






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






44. 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






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






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






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






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






49. 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.






50. Organization that accredits clearinghouses