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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. A computerized permanent record of all financial transactions between the patient and the pratice - also called patient ledger.
UB-04
Patient account record
Claims attachment
Delinquent account
2. 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.
Value-added network (VAN)
Accounts receivable aging report
Electronic claim processing
Noncovered benefit
3. The transmission of claims data (electronical or manually) to payers or clearinghouses for processing.
Claims submission
Accept assignment
Encounter form
Accounts receivable
4. Associated with how an insurance plan is billed-the insurance plan responsible for paying healthcare insurance claims first is considered primary.
Primary insurance
Fair debt collection practicies Act
Manual daily accounts receivable journal
Open claim
5. The term hospitals use to describe the encounter form.
Guarantor
Chargemaster
Source document
Accounts receivable aging report
6. The maximum amount a payer will reimburse for each procedure or service - according to the patient's policy.
Consumer Credit Protection Act of 1968
Outsourcing
Allowed charges
Fair debt collection practicies Act
7. Medical report substantiating a medical condition
Claims attachment
Claims adjudication
Two-party check
Superbill
8. Person responsible for paying healthcare fees
Guarantor
Fair debt collection practicies Act
Fair credit reporting Act
Patient ledger
9. A correctly completed standardized claim
Deductible
ANSI ASC X12 standards
Clean claim
Bad debt
10. Claims for which all processing - including appeals - has been completed.
Closed claim
Electronic media claim
Pre-existing condition
Birthday rule
11. 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;
Beneficiary
Accept assignment
Fair Credit and Charge Card Disclosure ACT
Outsourcing
12. A claim that is usually more than 120 days past due; some practices establish time frames that are less than 120 days.
Participating provider
Covered entity
Deliquent claim
Electronic funds transfer ACT
13. Legal action to recover a debt; usually a last resort for a medical practice.
Equal Credit Opportunity ACT
Litigation
Beneficiary
Birthday rule
14. Establishes the rights. liabilites - and rsponsibilities of participants in electronic funds transfer systems.
Electronic funds transfer ACT
Unassigned claim
Consumer Credit Protection Act of 1968
Deductible
15. Advances through various aging periods( 30 -60 -90 -120) with practices typically focusing internal recovery efforts on older delinquent accounts.
Two-party check
Clean claim
Delinquent claim cycle
Accept assignment
16. Accounts receivable that cannot be collected by the provider or a collect agency.
Downcoding
Patient ledger
Fair debt collection practicies Act
Bad debt
17. Theperson eligible to receive healthcare benefits.
Beneficiary
Consumer Credit Protection Act of 1968
Common data file
Chargemaster
18. Amount for which the patient is financially responsible before an insurance company provides coverage.
Electronic remittance advi
Out-of-pocket payment
Outsourcing
Deductible
19. Services that are provided to a patient without proper authorization or that are not covered by a current authorization.
Equal Credit Opportunity ACT
Unauthorized service
Fair debt collection practicies Act
Electronic claim processing
20. 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.
Encounter form
Coordination of benefits (COB)
Electronic claim processing
Electronic remittance advi
21. The provider receives reimbursement directly from the payer.
Past-due account
Assignment of benefits
Manual daily accounts receivable journal
Accounts receivable management
22. Series of fixed length records submitted to payers to bill for health care services.
Coordination of benefits (COB)
Value-added network (VAN)
Electronic funds transfer
Electronic flat file format
23. The insurance claim form used to report professional services
Birthday rule
Covered entity
Delinquent account
CMS-1500
24. Shows the status (by date) of outstanding claims from each payer - as well as payments due from patients
Electronic media claim
Electronic flat file format
Patient account record
Accounts receivable aging report
25. Abstract of all recent claims filed on each patient.
Common data file
Deliquent claim
Coordination of benefits (COB)
Electronic remittance advi
26. 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
Bad debt
Allowed charges
Closed claim
Value-added network (VAN)
27. A check made out to the patient and the provider.
Primary insurance
Two-party check
Downcoding
Patient account record
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.
Electronic funds transfer
Consumer Credit Protection Act of 1968
Pre-existing condition
Encounter form
29. A computerized permanent record of all financial transactions between the patient and the practice;also called patient account record.
Superbill
Fair Credit Billing Act
Patient ledger
Delinquent claim cycle
30. Series of fixed length records submitted to payers to bill for health care services.
Primary insurance
Accounts receivable management
Electronic media claim
Coordination of benefits (COB)
31. Any medical condition that was diagnosed and or treated within a specified period of time immediately preceding the enrollee's effective date of coverage.
Claims submission
Pre-existing condition
Claims attachment
Clean claim
32. Specifies what a collection source may or may not do when pursuing payment on past due accounts.
Fair debt collection practicies Act
Accounts receivable management
Delinquent claim cycle
Unauthorized service
33. One that has not been paid within a certain time frame; also called delinquent account
Participating provider
Accounts receivable
ANSI ASC X12 standards
Past-due account
34. Assists providers in the collection of appropriate reimbursement for services rendered; includes functions such as insurance verfication/eligibility and preauthorization of services
Accounts receivable management
Open claim
Delinquent account
Electronic remittance advi
35. Uses a variable-length file format to process transactions for institutional - professional - dental - and drug claims.
ANSI ASC X12 standards
Deductible
Birthday rule
UB-04
36. 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
Provider Remittance Notice
Consumer Credit Protection Act of 1968
Out-of-pocket payment
37. A routing slip - charge slip - encounter form - or suberbill from which the insurance claim was generated.
Out-of-pocket payment
Consumer Credit Protection Act of 1968
Claims attachment
Source document
38. Determines coverage by primary and secondary policies when each parent subscribes to a different health insurance plan.
UB-04
Accept assignment
Birthday rule
Clearinghouse
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.
Electronic Healthcare Network Accreditation Commission EHNAC
Noncovered benefit
Two-party check
Electronic remittance advi
40. Is a past due account; one that has not been paid within a certain time frame.
Delinquent account
Consumer Credit Protection Act of 1968
Electronic flat file format
Electronic remittance advi
41. Also called manual daily accounts receivable journal; cronological summary of all transactions posted to individual patient legers/accounts on a specific day.
Closed claim
Electronic funds transfer ACT
Day sheet
Two-party check
42. Contract out
Litigation
Outsourcing
Birthday rule
ANSI ASC X12 standards
43. Term used for the encounter form in the physicians's office.
Consumer Credit Protection Act of 1968
Primary insurance
Two-party check
Superbill
44. 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
Two-party check
Coinsurance
Fair credit reporting Act
Delinquent account
45. Organization that accredits clearinghouses
Accounts receivable aging report
Electronic Healthcare Network Accreditation Commission EHNAC
Downcoding
Chargemaster
46. 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
Claims adjudication
Chargemaster
Electronic media claim
Claims attachment
47. Sorting claims upon submission to collect and verify information about a patient and provider.
Unauthorized service
Claims processing
Litigation
Out-of-pocket payment
48. Computer to computer data exchange between payer and provider
Outsourcing
Electronic data interchange EDI
Chargemaster
Common data file
49. Assigning lower-level codes then documented in the record.
Downcoding
Litigation
Claims attachment
Chargemaster
50. The amount owed to a business for services or goods provided
Provider Remittance Notice
Out-of-pocket payment
Accounts receivable
Source document