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






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






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






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






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






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






7. The insurance claim form used to report professional services






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






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






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






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






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






13. Person responsible for paying healthcare fees






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






15. 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;






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






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






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






19. The provider receives reimbursement directly from the payer.






20. 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.






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






24. Form used to report institutional - facility services.






25. 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






26. Organization that accredits clearinghouses






27. 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.






28. 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.






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






30. 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.






31. Theperson eligible to receive healthcare benefits.






32. Computer to computer data exchange between payer and provider






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






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






35. 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.






36. 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;






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






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






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






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






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






42. A correctly completed standardized claim






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






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






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






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






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






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






49. 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






50. Contract out