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. Abstract of all recent claims filed on each patient.






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






3. The insurance claim form used to report professional services






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






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






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






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






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






9. A correctly completed standardized claim






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






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






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






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






14. Medical report substantiating a medical condition






15. 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.






16. Computer to computer data exchange between payer and provider






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






18. 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






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






20. Person responsible for paying healthcare fees






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






22. 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






23. Clearinghouses that involves value-added vedors - such as banks - in the processing of claims; using a VAN is more efficient and less expensive for providers than managing their own systems to send and receive transactions directly from nummerous ent






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






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






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






27. 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;






28. 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






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






30. Theperson eligible to receive healthcare benefits.






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






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






33. 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.






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






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






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






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






38. Contract out






39. 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






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






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






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






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






44. Form used to report institutional - facility services.






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






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






47. 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.






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






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






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