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






2. Theperson eligible to receive healthcare benefits.






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






4. 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.






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






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






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






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






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






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






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






12. 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.






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






14. 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






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






16. Form used to report institutional - facility services.






17. Contract out






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






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






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






21. 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;






22. 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






23. The insurance claim form used to report professional services






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






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






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






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






28. Organization that accredits clearinghouses






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






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






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






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






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






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






35. 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






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






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






38. A correctly completed standardized claim






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






40. 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;






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






42. Person responsible for paying healthcare fees






43. 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






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






45. The provider receives reimbursement directly from the payer.






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






47. 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.






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






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






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