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. 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.






2. Form used to report institutional - facility services.






3. 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






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






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






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






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






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






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






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






11. The insurance claim form used to report professional services






12. 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






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






14. Contract out






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






16. Person responsible for paying healthcare fees






17. 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.






18. 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;






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






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






21. 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.






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






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






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






25. A correctly completed standardized claim






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






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






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






29. The provider receives reimbursement directly from the payer.






30. Medical report substantiating a medical condition






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






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






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






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






35. Organization that accredits clearinghouses






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






37. Theperson eligible to receive healthcare benefits.






38. 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






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






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






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






42. Advances through various aging periods( 30 -60 -90 -120) with practices typically focusing internal recovery efforts on older delinquent accounts.






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






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






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






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






47. 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.






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






49. 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






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