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






2. 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.






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






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






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






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






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






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






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






10. 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.






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






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






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. 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






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






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






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






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






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






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






21. The provider receives reimbursement directly from the payer.






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






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






24. 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.






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






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






27. Contract out






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






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






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






31. 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






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






33. 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






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






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






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






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






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






39. 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.






40. Theperson eligible to receive healthcare benefits.






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






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






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






44. A correctly completed standardized claim






45. Person responsible for paying healthcare fees






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






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






48. Form used to report institutional - facility services.






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






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