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






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






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






4. The provider receives reimbursement directly from the payer.






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






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






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






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






9. 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.






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






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






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






14. 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;






15. 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






16. Contract out






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






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






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






20. Computer to computer data exchange between payer and provider






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






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






23. 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






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






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






26. 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.






27. Theperson eligible to receive healthcare benefits.






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






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






30. Form used to report institutional - facility services.






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






32. 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.






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






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






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






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






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






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






39. The insurance claim form used to report professional services






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






41. A correctly completed standardized claim






42. 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.






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






44. Person responsible for paying healthcare fees






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






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






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






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






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






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