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Health Insurance

Subject : industries
  • Answer 50 questions in 15 minutes.
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  • Match each statement with the correct term.
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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. 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

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

3. The insurance claim form used to report professional services

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

5. Contract out

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

7. 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.

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

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

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

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

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

13. 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.

14. 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;

15. Person responsible for paying healthcare fees

16. 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

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

18. 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.

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

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

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

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

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

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

25. A correctly completed standardized claim

26. Medical report substantiating a medical condition

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

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

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

30. 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;

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

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

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

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

35. Theperson eligible to receive healthcare benefits.

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

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

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

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

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

41. 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

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

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

44. Form used to report institutional - facility services.

45. 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.

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

47. Organization that accredits clearinghouses

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

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

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