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






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






3. Contract out






4. Theperson eligible to receive healthcare benefits.






5. Computer to computer data exchange between payer and provider






6. 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.






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






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






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






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






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






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






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






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






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






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






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






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






19. The insurance claim form used to report professional services






20. Organization that accredits clearinghouses






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






22. The provider receives reimbursement directly from the payer.






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






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






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






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






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






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






29. 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;






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






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






32. 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






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






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






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






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






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






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






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






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






41. A correctly completed standardized claim






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






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






44. Form used to report institutional - facility services.






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






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






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






49. Medical report substantiating a medical condition






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