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. 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






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






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






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






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






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






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






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






9. Theperson eligible to receive healthcare benefits.






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






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






12. 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.






13. 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;






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






15. 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.






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






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






18. The provider receives reimbursement directly from the payer.






19. Computer to computer data exchange between payer and provider






20. The insurance claim form used to report professional services






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






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






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






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






26. 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






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






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






29. 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






30. 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.






31. 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






32. 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.






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






34. Person responsible for paying healthcare fees






35. Contract out






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






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






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






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






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






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






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






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






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






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






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






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






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






49. Form used to report institutional - facility services.






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