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






3. The insurance claim form used to report professional services






4. 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.






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






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






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






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






9. The provider receives reimbursement directly from the payer.






10. 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.






11. Specifies what a collection source may or may not do when pursuing payment on past due accounts.






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






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






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






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






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






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






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






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






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






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






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






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






24. Organization that accredits clearinghouses






25. 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.






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






27. Medical report substantiating a medical condition






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






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






30. 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






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






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






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






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






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






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






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






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






39. Contract out






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






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






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






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






44. 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;






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






46. A correctly completed standardized claim






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






48. Theperson eligible to receive healthcare benefits.






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






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