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Test your basic knowledge |
Health Insurance
Start Test
Study First
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. Term used for the encounter form in the physicians's office.
Pre-existing condition
Assignment of benefits
Litigation
Superbill
2. Sending data in a standardized machine readable format to an insurance company via disk - telephone or cable.
Fair credit reporting Act
Electronic claim processing
Manual daily accounts receivable journal
Electronic data interchange EDI
3. The term hospitals use to describe the encounter form.
Source document
Unassigned claim
Claims adjudication
Chargemaster
4. A routing slip - charge slip - encounter form - or suberbill from which the insurance claim was generated.
Source document
Delinquent account
Claims adjudication
Birthday rule
5. 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;
Fair debt collection practicies Act
Fair Credit and Charge Card Disclosure ACT
Assignment of benefits
Unbundling
6. Specifies what a collection source may or may not do when pursuing payment on past due accounts.
Common data file
Manual daily accounts receivable journal
Fair debt collection practicies Act
Guarantor
7. Legal action to recover a debt; usually a last resort for a medical practice.
Coordination of benefits (COB)
Litigation
Closed claim
Unbundling
8. Uses a variable-length file format to process transactions for institutional - professional - dental - and drug claims.
Equal Credit Opportunity ACT
ANSI ASC X12 standards
Birthday rule
Open claim
9. Any medical condition that was diagnosed and or treated within a specified period of time immediately preceding the enrollee's effective date of coverage.
Electronic media claim
Unauthorized service
Pre-existing condition
Fair Credit and Charge Card Disclosure ACT
10. 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.
Birthday rule
Guarantor
Electronic remittance advi
Noncovered benefit
11. Series of fixed length records submitted to payers to bill for health care services.
Common data file
Fair debt collection practicies Act
Electronic media claim
Claims attachment
12. Establishes the rights. liabilites - and rsponsibilities of participants in electronic funds transfer systems.
Electronic flat file format
Electronic funds transfer ACT
Electronic remittance advi
Guarantor
13. 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.
Noncovered benefit
Bad debt
Out-of-pocket payment
Superbill
14. Advances through various aging periods( 30 -60 -90 -120) with practices typically focusing internal recovery efforts on older delinquent accounts.
Electronic Healthcare Network Accreditation Commission EHNAC
Delinquent claim cycle
Out-of-pocket payment
Deliquent claim
15. 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
Coordination of benefits (COB)
Value-added network (VAN)
Day sheet
Claims submission
16. A correctly completed standardized claim
Accounts receivable management
Unauthorized service
Clearinghouse
Clean claim
17. Financial record source document used by providers and other personnel to record treated diagnoses and services rendered to the patient during the current encounter.
Encounter form
Litigation
Consumer Credit Protection Act of 1968
Electronic data interchange EDI
18. 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
Out-of-pocket payment
Delinquent account
Claims adjudication
Encounter form
19. Is a public or private entity that processes of facilitates the processing of nonstandard data elements into standard data elements.
Clearinghouse
Accept assignment
Source document
Delinquent claim cycle
20. 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
Primary insurance
Guarantor
Equal Credit Opportunity ACT
Fair credit reporting Act
21. 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
Patient account record
Electronic Healthcare Network Accreditation Commission EHNAC
Participating provider
Claims adjudication
22. The transmission of claims data (electronical or manually) to payers or clearinghouses for processing.
Claims submission
Downcoding
Coordination of benefits (COB)
Allowed charges
23. Amount for which the patient is financially responsible before an insurance company provides coverage.
Deductible
Electronic flat file format
Accounts receivable management
Claims attachment
24. System by which payers deposit funds to the providers account electronically.
Two-party check
Electronic funds transfer
Primary insurance
Fair Credit Billing Act
25. Is a past due account; one that has not been paid within a certain time frame.
Accounts receivable
Delinquent account
Downcoding
Source document
26. Submitting multiple CPT codes when one code could of been submitted.
Unbundling
Accounts receivable management
Consumer Credit Protection Act of 1968
Manual daily accounts receivable journal
27. Contracts with a helath insurance plan and accepts whatever the plan pays for procedures or services performed.
Participating provider
Value-added network (VAN)
Coordination of benefits (COB)
Fair Credit Billing Act
28. Does not contract with the insurance plan; patient who elects to recieve care from nonPARS will incur higher out-of-pocket expenses.
Nonparticipating provider
Electronic data interchange EDI
Electronic Healthcare Network Accreditation Commission EHNAC
Participating provider
29. Also called manual daily accounts receivable journal; cronological summary of all transactions posted to individual patient legers/accounts on a specific day.
Accounts receivable aging report
Day sheet
Outsourcing
Patient account record
30. Assigning lower-level codes then documented in the record.
Delinquent claim cycle
Downcoding
Patient account record
Patient ledger
31. Form used to report institutional - facility services.
Patient account record
UB-04
Past-due account
Superbill
32. The amount owed to a business for services or goods provided
Accounts receivable
Out-of-pocket payment
Deliquent claim
Claims attachment
33. Submitted to the payer - but processing is not complete
Bad debt
Outsourcing
Open claim
Assignment of benefits
34. Theperson eligible to receive healthcare benefits.
Participating provider
Equal Credit Opportunity ACT
Beneficiary
Nonparticipating provider
35. Shows the status (by date) of outstanding claims from each payer - as well as payments due from patients
Downcoding
Accounts receivable aging report
Equal Credit Opportunity ACT
Unbundling
36. Medical report substantiating a medical condition
Equal Credit Opportunity ACT
Claims attachment
Chargemaster
Open claim
37. Series of fixed length records submitted to payers to bill for health care services.
Deductible
Common data file
Electronic media claim
Electronic flat file format
38. Accounts receivable that cannot be collected by the provider or a collect agency.
Claims submission
Unbundling
Litigation
Bad debt
39. One that has not been paid within a certain time frame; also called delinquent account
Encounter form
Fair credit reporting Act
Past-due account
Closed claim
40. The insurance claim form used to report professional services
ANSI ASC X12 standards
Out-of-pocket payment
Equal Credit Opportunity ACT
CMS-1500
41. A computerized permanent record of all financial transactions between the patient and the practice;also called patient account record.
Patient ledger
Claims processing
Nonparticipating provider
Deductible
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.
Electronic Healthcare Network Accreditation Commission EHNAC
Fair credit reporting Act
Coinsurance
Coordination of benefits (COB)
43. Health plans - healthcare clearinghouses - government health plans - and any health providers that choose to submit or receive transactions electronically.
Beneficiary
Covered entity
Electronic claim processing
Electronic funds transfer ACT
44. A computerized permanent record of all financial transactions between the patient and the pratice - also called patient ledger.
Clean claim
Assignment of benefits
Patient account record
Electronic data interchange EDI
45. Remittance advice submitted by Medicare to providers that includes payment information about a claim.
Guarantor
Claims adjudication
Provider Remittance Notice
Claims processing
46. When the provider agrees to accept what the insurance company allows or aproves as payment in full for the claim
Fair debt collection practicies Act
ANSI ASC X12 standards
Accept assignment
Common data file
47. Assists providers in the collection of appropriate reimbursement for services rendered; includes functions such as insurance verfication/eligibility and preauthorization of services
Provider Remittance Notice
Day sheet
Accounts receivable management
Nonparticipating provider
48. Claims for which all processing - including appeals - has been completed.
Electronic funds transfer
Bad debt
Equal Credit Opportunity ACT
Closed claim
49. 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.
Open claim
Patient ledger
Claims processing
Unassigned claim
50. 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.
Source document
Equal Credit Opportunity ACT
Closed claim
Accounts receivable aging report