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






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






3. 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;






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






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






6. 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.






7. 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






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






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






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






11. 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






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






13. 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






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






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






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






17. 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;






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






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






20. A correctly completed standardized claim






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






22. 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.






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






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






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






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






27. A computerized permanent record of all financial transactions between the patient and the pratice - also called patient ledger.






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






29. 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






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






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






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






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






34. 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.






35. The insurance claim form used to report professional services






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






37. The provider receives reimbursement directly from the payer.






38. Organization that accredits clearinghouses






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






40. Medical report substantiating a medical condition






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






42. Contract out






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






44. Person responsible for paying healthcare fees






45. 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.






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






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






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






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






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