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. Theperson eligible to receive healthcare benefits.






2. A correctly completed standardized claim






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






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






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






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






7. Contract out






8. Person responsible for paying healthcare fees






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






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






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






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






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






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






15. 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






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






17. 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






18. 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






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






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






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






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






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






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






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






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






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






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






29. The maximum amount a payer will reimburse for each procedure or service - according to the patient's policy.






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






31. The insurance claim form used to report professional services






32. 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.






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






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






36. 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.






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






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






39. 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;






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






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






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.






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






44. Medical report substantiating a medical condition






45. The provider receives reimbursement directly from the payer.






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






47. 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






48. Does not contract with the insurance plan; patient who elects to recieve care from nonPARS will incur higher out-of-pocket expenses.






49. Organization that accredits clearinghouses






50. 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