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Health Insurance

Subject : industries
Instructions:
  • Answer 50 questions in 15 minutes.
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  • Match each statement with the correct term.
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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. Also called manual daily accounts receivable journal; cronological summary of all transactions posted to individual patient legers/accounts on a specific day.






2. 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.






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






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






5. Medical report substantiating a medical condition






6. 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.






7. 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






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






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






10. Person responsible for paying healthcare fees






11. 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;






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






13. A correctly completed standardized claim






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






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






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






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






19. Contract out






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






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






22. Theperson eligible to receive healthcare benefits.






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






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






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






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






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






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






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






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






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






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






33. 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.






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






35. The insurance claim form used to report professional services






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






37. Form used to report institutional - facility services.






38. 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;






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






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






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






42. 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






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






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






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






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






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






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






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






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







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