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






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






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






4. The provider receives reimbursement directly from the payer.






5. 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.






6. Computer to computer data exchange between payer and provider






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






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






10. 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






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






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






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






14. A correctly completed standardized claim






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






16. Form used to report institutional - facility services.






17. 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.






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






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






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






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






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






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






24. Theperson eligible to receive healthcare benefits.






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






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






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






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






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






31. 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;






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






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






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






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






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






37. 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






38. 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






39. 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.






40. 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.






41. Organization that accredits clearinghouses






42. The insurance claim form used to report professional services






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






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






45. Person responsible for paying healthcare fees






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






47. 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.






48. 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;






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






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