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






2. A correctly completed standardized claim






3. 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






4. 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.






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






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






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






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






9. Theperson eligible to receive healthcare benefits.






10. The provider receives reimbursement directly from the payer.






11. 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






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






13. Contract out






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






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






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






17. Person responsible for paying healthcare fees






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






19. 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.






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






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






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






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






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






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






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






27. Organization that accredits clearinghouses






28. 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






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






30. 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;






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






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






33. 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.






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






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






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






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






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






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






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






41. Medical report substantiating a medical condition






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






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






44. 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.






45. Form used to report institutional - facility services.






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






47. 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;






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






49. 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.






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