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. 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;






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






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






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






5. 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.






6. Organization that accredits clearinghouses






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






8. Person responsible for paying healthcare fees






9. Theperson eligible to receive healthcare benefits.






10. Medical report substantiating a medical condition






11. 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.






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






13. Form used to report institutional - facility services.






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






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






16. 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






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






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






19. 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.






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






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






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






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






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






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






27. The insurance claim form used to report professional services






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






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






30. The provider receives reimbursement directly from the payer.






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






32. 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.






33. 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






34. Contract out






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






36. 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;






37. 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






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






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






40. 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.






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






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






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






44. A correctly completed standardized claim






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






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






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






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






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






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