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






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






3. Person responsible for paying healthcare fees






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






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






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






7. 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






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






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






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






11. 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






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






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






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






15. 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.






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






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






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






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






20. 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.






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






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






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






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






25. Organization that accredits clearinghouses






26. 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






27. Medical report substantiating a medical condition






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






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






30. 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.






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






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






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






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






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






36. The insurance claim form used to report professional services






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






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






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






40. The provider receives reimbursement directly from the payer.






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






42. Theperson eligible to receive healthcare benefits.






43. Form used to report institutional - facility services.






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






45. 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






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






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






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






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






50. Computer to computer data exchange between payer and provider






Can you answer 50 questions in 15 minutes?



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