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Health Insurance

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

2. A correctly completed standardized claim

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

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

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

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

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

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

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

10. 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;

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

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

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

14. 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.

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

16. Contract out

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

18. 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.

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

20. 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

21. 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.

22. 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.

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

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

25. Person responsible for paying healthcare fees

26. 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

27. 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

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

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

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

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

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

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

34. 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.

35. Theperson eligible to receive healthcare benefits.

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

37. The provider receives reimbursement directly from the payer.

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

39. The insurance claim form used to report professional services

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

41. 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;

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

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

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

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

46. Form used to report institutional - facility services.

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

48. Medical report substantiating a medical condition

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

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