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. A correctly completed standardized claim






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






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






4. 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






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






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






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






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






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






11. 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;






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






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






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






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






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






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






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






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






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






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






22. Medical report substantiating a medical condition






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






24. Contract out






25. 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






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






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






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






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






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






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






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






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






34. The insurance claim form used to report professional services






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






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






37. Theperson eligible to receive healthcare benefits.






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






39. 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






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






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






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






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






44. 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






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






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






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






48. The provider receives reimbursement directly from the payer.






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






50. Computer to computer data exchange between payer and provider