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






2. 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






3. 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






4. Computer to computer data exchange between payer and provider






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






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






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






8. 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;






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






10. 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;






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






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






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






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






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






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






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






18. Contract out






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






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






21. 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






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






23. 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.






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






25. Form used to report institutional - facility services.






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






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






28. The insurance claim form used to report professional services






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






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






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






32. A correctly completed standardized claim






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






34. 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.






35. 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






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






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






38. Person responsible for paying healthcare fees






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






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






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






42. 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.






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






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






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






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






47. Theperson eligible to receive healthcare benefits.






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






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






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