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






2. Theperson eligible to receive healthcare benefits.






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






4. 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.






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






6. Person responsible for paying healthcare fees






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






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






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






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






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






12. Contract out






13. Form used to report institutional - facility services.






14. 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






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






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






17. 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






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






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






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






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






22. A correctly completed standardized claim






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






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






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






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






27. Computer to computer data exchange between payer and provider






28. 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






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






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






31. 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






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






33. 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;






34. Organization that accredits clearinghouses






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






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






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






38. 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;






39. 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.






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






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






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






43. 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.






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






45. The insurance claim form used to report professional services






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






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






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






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






50. 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