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






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






3. 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






4. 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






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






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






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






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






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






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






11. 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.






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






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






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






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






16. A correctly completed standardized claim






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






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






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






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






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






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






23. 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.






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






25. The insurance claim form used to report professional services






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






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






28. 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.






29. 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;






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






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






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






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






34. Form used to report institutional - facility services.






35. Organization that accredits clearinghouses






36. A claim that is usually more than 120 days past due; some practices establish time frames that are less than 120 days.






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






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






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






40. 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.






41. Computer to computer data exchange between payer and provider






42. 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






43. Contract out






44. Person responsible for paying healthcare fees






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






46. The provider receives reimbursement directly from the payer.






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






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






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






50. Theperson eligible to receive healthcare benefits.