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






3. Form used to report institutional - facility services.






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






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






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






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






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






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






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






11. 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






12. 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.






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






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






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






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






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






18. The insurance claim form used to report professional services






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






20. 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






21. Theperson eligible to receive healthcare benefits.






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






23. 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.






24. 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






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






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






27. 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






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






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






30. 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;






31. The provider receives reimbursement directly from the payer.






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






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






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






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






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






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






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






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. Person responsible for paying healthcare fees






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






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






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






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






45. Organization that accredits clearinghouses






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






47. 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.






48. 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;






49. Contract out






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






Can you answer 50 questions in 15 minutes?



Let me suggest you:

Browse all subjects

Browse all tests

Most popular tests



Major Subjects

Tests & Exams


AP
CLEP
DSST
GRE
SAT
GMAT

Browse all subjects

Browse all tests

Most popular tests