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. 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






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






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






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






5. 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.






6. Medical report substantiating a medical condition






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






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






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






10. Contract out






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






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






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






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






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






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






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






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






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






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






21. 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






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






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






24. The insurance claim form used to report professional services






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






26. 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;






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






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






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






30. 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.






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






32. Person responsible for paying healthcare fees






33. A correctly completed standardized claim






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






35. Organization that accredits clearinghouses






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






37. The provider receives reimbursement directly from the payer.






38. 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.






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






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






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






42. 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






43. Computer to computer data exchange between payer and provider






44. 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






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






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






47. 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






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






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






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