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