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. 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.






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






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






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






5. The insurance claim form used to report professional services






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






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






8. A correctly completed standardized claim






9. 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






10. 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.






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






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






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






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






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






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






17. Medical report substantiating a medical condition






18. 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






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






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






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






22. Person responsible for paying healthcare fees






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






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






25. 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.






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






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






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






29. Form used to report institutional - facility services.






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






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






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






33. 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;






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






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






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






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






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






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






40. Computer to computer data exchange between payer and provider






41. 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






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






43. 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.






44. Contract out






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






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






47. Organization that accredits clearinghouses






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






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






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