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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. 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

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

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

4. Person responsible for paying healthcare fees

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

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

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

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

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

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

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

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

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

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

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

17. 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;

18. 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.

19. Theperson eligible to receive healthcare benefits.

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

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

22. 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.

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

24. Medical report substantiating a medical condition

25. 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

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

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

28. 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

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

30. Organization that accredits clearinghouses

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

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

33. Form used to report institutional - facility services.

34. The insurance claim form used to report professional services

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

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

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

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

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

40. 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.

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

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

43. 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

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

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

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

47. 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.

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

49. 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.

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