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






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






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






4. 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.






5. Contract out






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






7. Form used to report institutional - facility services.






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






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






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






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






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






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






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






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






17. 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






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






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






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






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






22. Person responsible for paying healthcare fees






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






24. 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.






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






26. The insurance claim form used to report professional services






27. Organization that accredits clearinghouses






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






29. Computer to computer data exchange between payer and provider






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






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






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






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






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






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






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






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






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






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






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






41. The provider receives reimbursement directly from the payer.






42. 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.






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






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






45. A correctly completed standardized claim






46. 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.






47. 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;






48. 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.






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






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