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






2. Contract out






3. The provider receives reimbursement directly from the payer.






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






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






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






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






8. 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.






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






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






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






13. 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






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






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






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






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






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






20. 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;






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






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






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






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






25. Theperson eligible to receive healthcare benefits.






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






27. 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






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






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






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






31. 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.






32. Organization that accredits clearinghouses






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






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






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






36. 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.






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






38. 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.






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






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






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






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






43. A correctly completed standardized claim






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






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






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






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






48. The insurance claim form used to report professional services






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






50. Medical report substantiating a medical condition