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






2. 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.






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






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






5. A correctly completed standardized claim






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






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






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






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






10. The insurance claim form used to report professional services






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






12. 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.






13. 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






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






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






16. 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.






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






18. Computer to computer data exchange between payer and provider






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






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






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






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






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






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






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






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






27. Medical report substantiating a medical condition






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






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






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






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






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






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






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






35. 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






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






37. 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;






38. The provider receives reimbursement directly from the payer.






39. 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.






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






41. Contract out






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






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






44. 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;






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






46. 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






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






48. 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.






49. Person responsible for paying healthcare fees






50. Organization that accredits clearinghouses