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. Medical report substantiating a medical condition






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






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






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






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






7. 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.






8. Person responsible for paying healthcare fees






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






10. 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.






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






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






13. 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






14. A correctly completed standardized claim






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






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






17. Any medical condition that was diagnosed and or treated within a specified period of time immediately preceding the enrollee's effective date of coverage.






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






19. 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






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






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






22. 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






23. 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;






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






25. Organization that accredits clearinghouses






26. The insurance claim form used to report professional services






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






28. 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






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






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






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






33. Abstract of all recent claims filed on each patient.






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






35. 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.






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






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






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






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






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






41. 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.






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






43. Computer to computer data exchange between payer and provider






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






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






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






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






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






49. Form used to report institutional - facility services.






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