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






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






3. Organization that accredits clearinghouses






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






5. 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;






6. 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.






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






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






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






10. Person responsible for paying healthcare fees






11. 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






12. 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;






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






14. The provider receives reimbursement directly from the payer.






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






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






17. Contract out






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






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






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






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






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






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






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






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






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






27. Form used to report institutional - facility services.






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






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






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






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






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






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






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






35. 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.






36. Medical report substantiating a medical condition






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






38. 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






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






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






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






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






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






45. 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






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






47. 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






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






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






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






Can you answer 50 questions in 15 minutes?



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