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Test your basic knowledge |
Health Insurance
Start Test
Study First
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
Litigation
Clearinghouse
Delinquent claim cycle
Accounts receivable aging report
2. 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
Accounts receivable
Electronic media claim
Out-of-pocket payment
Fair credit reporting Act
3. A claim that is usually more than 120 days past due; some practices establish time frames that are less than 120 days.
Delinquent account
Deliquent claim
Unassigned claim
Clean claim
4. 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.
Unassigned claim
Superbill
Allowed charges
Guarantor
5. The amount owed to a business for services or goods provided
ANSI ASC X12 standards
Electronic funds transfer
Accounts receivable
Unassigned claim
6. A computerized permanent record of all financial transactions between the patient and the practice;also called patient account record.
Unassigned claim
Patient ledger
Primary insurance
Nonparticipating provider
7. Any medical condition that was diagnosed and or treated within a specified period of time immediately preceding the enrollee's effective date of coverage.
Value-added network (VAN)
Electronic funds transfer ACT
Encounter form
Pre-existing condition
8. Abstract of all recent claims filed on each patient.
Unassigned claim
Common data file
Clearinghouse
Two-party check
9. Amount for which the patient is financially responsible before an insurance company provides coverage.
Superbill
Electronic funds transfer
Deductible
Accounts receivable
10. Advances through various aging periods( 30 -60 -90 -120) with practices typically focusing internal recovery efforts on older delinquent accounts.
Closed claim
Claims adjudication
Claims processing
Delinquent claim cycle
11. Also called a day sheet - a chronological summary of all transactions posted to individual patient ledgers/accounts on a specific day.
Birthday rule
Fair credit reporting Act
Manual daily accounts receivable journal
Deductible
12. 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.
Noncovered benefit
Claims processing
Provider Remittance Notice
Downcoding
13. 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
Covered entity
Electronic remittance advi
Unbundling
Value-added network (VAN)
14. 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.
Equal Credit Opportunity ACT
Chargemaster
Participating provider
Birthday rule
15. The maximum amount a payer will reimburse for each procedure or service - according to the patient's policy.
Covered entity
Electronic funds transfer
Allowed charges
Encounter form
16. Associated with how an insurance plan is billed-the insurance plan responsible for paying healthcare insurance claims first is considered primary.
Primary insurance
CMS-1500
Deliquent claim
Consumer Credit Protection Act of 1968
17. The transmission of claims data (electronical or manually) to payers or clearinghouses for processing.
Claims submission
Claims processing
Electronic funds transfer
CMS-1500
18. Legal action to recover a debt; usually a last resort for a medical practice.
Claims processing
Electronic data interchange EDI
Electronic Healthcare Network Accreditation Commission EHNAC
Litigation
19. Submitted to the payer - but processing is not complete
Coordination of benefits (COB)
Electronic media claim
Open claim
Delinquent account
20. Series of fixed length records submitted to payers to bill for health care services.
Beneficiary
Electronic media claim
Electronic data interchange EDI
Electronic claim processing
21. A check made out to the patient and the provider.
Chargemaster
Electronic remittance advi
Two-party check
Fair Credit Billing Act
22. The term hospitals use to describe the encounter form.
Accounts receivable management
Out-of-pocket payment
Chargemaster
Open claim
23. Contracts with a helath insurance plan and accepts whatever the plan pays for procedures or services performed.
Accounts receivable
Unbundling
Participating provider
Pre-existing condition
24. Person responsible for paying healthcare fees
Covered entity
Delinquent account
Guarantor
UB-04
25. Is a public or private entity that processes of facilitates the processing of nonstandard data elements into standard data elements.
Beneficiary
Common data file
Patient account record
Clearinghouse
26. Form used to report institutional - facility services.
Provider Remittance Notice
Electronic funds transfer
CMS-1500
UB-04
27. Establishes the rights. liabilites - and rsponsibilities of participants in electronic funds transfer systems.
Electronic funds transfer
Electronic funds transfer ACT
Equal Credit Opportunity ACT
Unauthorized service
28. Sorting claims upon submission to collect and verify information about a patient and provider.
Accept assignment
Electronic media claim
UB-04
Claims processing
29. Submitting multiple CPT codes when one code could of been submitted.
Covered entity
Downcoding
Coordination of benefits (COB)
Unbundling
30. Does not contract with the insurance plan; patient who elects to recieve care from nonPARS will incur higher out-of-pocket expenses.
Accounts receivable
Nonparticipating provider
Two-party check
Birthday rule
31. Term used for the encounter form in the physicians's office.
CMS-1500
Birthday rule
Litigation
Superbill
32. Specifies what a collection source may or may not do when pursuing payment on past due accounts.
Coordination of benefits (COB)
Accept assignment
Fair debt collection practicies Act
Clean claim
33. Financial record source document used by providers and other personnel to record treated diagnoses and services rendered to the patient during the current encounter.
Coordination of benefits (COB)
Electronic funds transfer ACT
Encounter form
Patient account record
34. When the provider agrees to accept what the insurance company allows or aproves as payment in full for the claim
Provider Remittance Notice
Past-due account
Fair credit reporting Act
Accept assignment
35. The provider receives reimbursement directly from the payer.
Downcoding
Assignment of benefits
Patient ledger
Closed claim
36. Contract out
Outsourcing
Participating provider
Closed claim
Electronic Healthcare Network Accreditation Commission EHNAC
37. Services that are provided to a patient without proper authorization or that are not covered by a current authorization.
Delinquent claim cycle
Unauthorized service
Equal Credit Opportunity ACT
Unbundling
38. 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.
Unassigned claim
Past-due account
Coordination of benefits (COB)
Chargemaster
39. Series of fixed length records submitted to payers to bill for health care services.
Source document
Patient account record
Equal Credit Opportunity ACT
Electronic flat file format
40. 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
Patient account record
Deductible
Past-due account
Consumer Credit Protection Act of 1968
41. Claims for which all processing - including appeals - has been completed.
Covered entity
Claims submission
Open claim
Closed claim
42. System by which payers deposit funds to the providers account electronically.
Electronic funds transfer
Accept assignment
Source document
Electronic media claim
43. 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.
Electronic remittance advi
Electronic claim processing
Beneficiary
Accept assignment
44. Assigning lower-level codes then documented in the record.
Claims attachment
Downcoding
Unassigned claim
Beneficiary
45. Assists providers in the collection of appropriate reimbursement for services rendered; includes functions such as insurance verfication/eligibility and preauthorization of services
Fair debt collection practicies Act
Accounts receivable management
Clean claim
Day sheet
46. Is a past due account; one that has not been paid within a certain time frame.
Noncovered benefit
Delinquent account
Deductible
Unbundling
47. Computer to computer data exchange between payer and provider
Accounts receivable
Electronic data interchange EDI
Electronic remittance advi
Coordination of benefits (COB)
48. 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;
Clean claim
Downcoding
Delinquent account
Fair Credit and Charge Card Disclosure ACT
49. Remittance advice submitted by Medicare to providers that includes payment information about a claim.
Two-party check
Electronic flat file format
Provider Remittance Notice
Participating provider
50. A computerized permanent record of all financial transactions between the patient and the pratice - also called patient ledger.
Electronic remittance advi
Accept assignment
Patient account record
Assignment of benefits