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






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






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






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






6. 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.






7. 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;






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






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






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






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






12. 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






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






14. The insurance claim form used to report professional services






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






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






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






18. Organization that accredits clearinghouses






19. 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






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






21. 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;






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






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






24. A correctly completed standardized claim






25. Person responsible for paying healthcare fees






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






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






28. 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.






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






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






31. Contract out






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






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






34. 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






35. Medical report substantiating a medical condition






36. 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






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






38. 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






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






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






41. 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.






42. 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.






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






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






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






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






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






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






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






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