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






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






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






5. A correctly completed standardized claim






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






8. 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






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






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






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






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






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






14. Theperson eligible to receive healthcare benefits.






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






16. Medical report substantiating a medical condition






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






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






19. 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






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






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






22. The insurance claim form used to report professional services






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






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






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






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






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






28. Contract out






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






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






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






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






33. 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;






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






35. Computer to computer data exchange between payer and provider






36. 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;






37. The provider receives reimbursement directly from the payer.






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






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






40. 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.






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






42. 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






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






44. Person responsible for paying healthcare fees






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






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






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






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






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






50. Organization that accredits clearinghouses