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






2. 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.






3. 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






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






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






6. 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






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






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






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






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






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






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






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






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






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






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






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






18. Theperson eligible to receive healthcare benefits.






19. 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;






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






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






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






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






24. The provider receives reimbursement directly from the payer.






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






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






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






28. Medical report substantiating a medical condition






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






30. A correctly completed standardized claim






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






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






33. Computer to computer data exchange between payer and provider






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






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






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






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






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






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






40. 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






41. 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.






42. Form used to report institutional - facility services.






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






44. Person responsible for paying healthcare fees






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






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






47. 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






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






49. 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.






50. Organization that accredits clearinghouses