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






2. Medical report substantiating a medical condition






3. Organization that accredits clearinghouses






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






5. A correctly completed standardized claim






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






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






8. The provider receives reimbursement directly from the payer.






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






10. 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






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






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






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






14. 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;






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






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






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






18. Person responsible for paying healthcare fees






19. Form used to report institutional - facility services.






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






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






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






23. 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






24. 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;






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






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






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






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






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






30. 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.






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






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






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






34. 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.






35. 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.






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






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






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






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






41. The insurance claim form used to report professional services






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






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






44. Theperson eligible to receive healthcare benefits.






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






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






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






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






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






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






Can you answer 50 questions in 15 minutes?



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