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