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. Contract out






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






3. 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.






4. The provider receives reimbursement directly from the payer.






5. Organization that accredits clearinghouses






6. 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






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






8. 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;






9. The insurance claim form used to report professional services






10. Form used to report institutional - facility services.






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






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






13. 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.






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






15. A correctly completed standardized claim






16. 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






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






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






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






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






21. Computer to computer data exchange between payer and provider






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






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






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






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






26. 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






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






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






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






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






31. 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






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






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






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






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






36. 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.






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






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






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






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






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






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






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






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






45. 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






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






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






48. Medical report substantiating a medical condition






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






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;