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






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






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






4. Person responsible for paying healthcare fees






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






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






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






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






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






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






11. 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.






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






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






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






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






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






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






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






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






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






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






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






23. Organization that accredits clearinghouses






24. Theperson eligible to receive healthcare benefits.






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






26. 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.






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






28. 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






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






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






31. 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






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






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






34. 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






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






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






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






38. 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.






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






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






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






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






43. 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






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






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






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






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






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






49. The insurance claim form used to report professional services






50. 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;