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






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






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






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






5. 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.






6. Theperson eligible to receive healthcare benefits.






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






8. The insurance claim form used to report professional services






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






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






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






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






13. 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;






14. 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.






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






16. A correctly completed standardized claim






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






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






19. Person responsible for paying healthcare fees






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






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






22. 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;






23. Contract out






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






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






26. 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






27. 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.






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






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






30. The provider receives reimbursement directly from the payer.






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






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






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






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






35. Computer to computer data exchange between payer and provider






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






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






38. Medical report substantiating a medical condition






39. 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






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






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






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






43. Form used to report institutional - facility services.






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






45. 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






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






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






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






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






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