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






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






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






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






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






6. Computer to computer data exchange between payer and provider






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






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






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






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






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






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






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






14. 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






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






16. 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.






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






18. Medical report substantiating a medical condition






19. 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;






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






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






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






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






24. 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.






25. Form used to report institutional - facility services.






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






27. Person responsible for paying healthcare fees






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






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






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






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






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






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






34. 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






35. 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.






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






37. 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






38. 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;






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






40. A correctly completed standardized claim






41. Theperson eligible to receive healthcare benefits.






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






43. 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






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






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






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






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






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






49. Contract out






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