SUBJECTS
|
BROWSE
|
CAREER CENTER
|
POPULAR
|
JOIN
|
LOGIN
Business Skills
|
Soft Skills
|
Basic Literacy
|
Certifications
About
|
Help
|
Privacy
|
Terms
|
Email
Search
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. 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
Deductible
Delinquent claim cycle
Accounts receivable aging report
Claims adjudication
2. Computer to computer data exchange between payer and provider
Fair debt collection practicies Act
Equal Credit Opportunity ACT
Deductible
Electronic data interchange EDI
3. Contracts with a helath insurance plan and accepts whatever the plan pays for procedures or services performed.
Source document
Accounts receivable aging report
Participating provider
UB-04
4. 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.
Nonparticipating provider
Primary insurance
Coordination of benefits (COB)
Fair debt collection practicies Act
5. A computerized permanent record of all financial transactions between the patient and the practice;also called patient account record.
Closed claim
Deductible
Patient ledger
Coordination of benefits (COB)
6. Also called a day sheet - a chronological summary of all transactions posted to individual patient ledgers/accounts on a specific day.
Deductible
Chargemaster
Manual daily accounts receivable journal
Birthday rule
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
Consumer Credit Protection Act of 1968
Guarantor
Source document
Accounts receivable management
8. Amount for which the patient is financially responsible before an insurance company provides coverage.
Fair Credit Billing Act
Deductible
Two-party check
Equal Credit Opportunity ACT
9. Services that are provided to a patient without proper authorization or that are not covered by a current authorization.
Noncovered benefit
Beneficiary
Unauthorized service
Claims submission
10. Establishes the rights. liabilites - and rsponsibilities of participants in electronic funds transfer systems.
Electronic funds transfer ACT
Value-added network (VAN)
Birthday rule
Provider Remittance Notice
11. 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
Coordination of benefits (COB)
Nonparticipating provider
Claims attachment
12. 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
Value-added network (VAN)
Past-due account
Electronic funds transfer ACT
Deductible
13. 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.
Encounter form
Accounts receivable management
Noncovered benefit
Coinsurance
14. Advances through various aging periods( 30 -60 -90 -120) with practices typically focusing internal recovery efforts on older delinquent accounts.
Delinquent claim cycle
Outsourcing
Accounts receivable aging report
Claims submission
15. Sorting claims upon submission to collect and verify information about a patient and provider.
Closed claim
Unbundling
Claims processing
Primary insurance
16. 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;
CMS-1500
Past-due account
Fair Credit Billing Act
Electronic claim processing
17. The transmission of claims data (electronical or manually) to payers or clearinghouses for processing.
Noncovered benefit
Claims submission
Accept assignment
Allowed charges
18. Series of fixed length records submitted to payers to bill for health care services.
Electronic flat file format
Participating provider
Chargemaster
Electronic remittance advi
19. 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
Assignment of benefits
Fair credit reporting Act
Electronic flat file format
Nonparticipating provider
20. Shows the status (by date) of outstanding claims from each payer - as well as payments due from patients
Allowed charges
Encounter form
Clean claim
Accounts receivable aging report
21. Also called manual daily accounts receivable journal; cronological summary of all transactions posted to individual patient legers/accounts on a specific day.
Accounts receivable aging report
Manual daily accounts receivable journal
Day sheet
Deductible
22. A claim that is usually more than 120 days past due; some practices establish time frames that are less than 120 days.
Equal Credit Opportunity ACT
Bad debt
Deliquent claim
Patient account record
23. Legal action to recover a debt; usually a last resort for a medical practice.
Litigation
Claims submission
Equal Credit Opportunity ACT
Unbundling
24. Sending data in a standardized machine readable format to an insurance company via disk - telephone or cable.
Electronic claim processing
Delinquent claim cycle
Two-party check
Claims adjudication
25. One that has not been paid within a certain time frame; also called delinquent account
Fair Credit and Charge Card Disclosure ACT
Past-due account
Electronic flat file format
Covered entity
26. Remittance advice submitted by Medicare to providers that includes payment information about a claim.
Noncovered benefit
Primary insurance
Provider Remittance Notice
Unbundling
27. A routing slip - charge slip - encounter form - or suberbill from which the insurance claim was generated.
Clearinghouse
Chargemaster
Source document
ANSI ASC X12 standards
28. The percentage the patient pays for covered services after the deductible has been met and the copayment has been paid.
Delinquent account
Coinsurance
Primary insurance
Manual daily accounts receivable journal
29. Is a public or private entity that processes of facilitates the processing of nonstandard data elements into standard data elements.
Covered entity
Fair credit reporting Act
Clearinghouse
Beneficiary
30. Submitted to the payer - but processing is not complete
Open claim
Clearinghouse
Claims adjudication
Electronic remittance advi
31. Abstract of all recent claims filed on each patient.
Value-added network (VAN)
Common data file
Participating provider
Two-party check
32. Theperson eligible to receive healthcare benefits.
Electronic Healthcare Network Accreditation Commission EHNAC
Downcoding
Delinquent claim cycle
Beneficiary
33. Financial record source document used by providers and other personnel to record treated diagnoses and services rendered to the patient during the current encounter.
Fair credit reporting Act
Assignment of benefits
Participating provider
Encounter form
34. Associated with how an insurance plan is billed-the insurance plan responsible for paying healthcare insurance claims first is considered primary.
Closed claim
Source document
Primary insurance
Participating provider
35. Submitting multiple CPT codes when one code could of been submitted.
Open claim
Claims submission
Fair debt collection practicies Act
Unbundling
36. 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.
Deductible
Equal Credit Opportunity ACT
Past-due account
Claims attachment
37. Is a past due account; one that has not been paid within a certain time frame.
Unassigned claim
Fair Credit Billing Act
Electronic claim processing
Delinquent account
38. Claims for which all processing - including appeals - has been completed.
Accounts receivable
Closed claim
ANSI ASC X12 standards
Fair Credit Billing Act
39. Uses a variable-length file format to process transactions for institutional - professional - dental - and drug claims.
Accounts receivable
Fair Credit and Charge Card Disclosure ACT
Claims submission
ANSI ASC X12 standards
40. Form used to report institutional - facility services.
Patient account record
UB-04
Electronic media claim
Clearinghouse
41. Assists providers in the collection of appropriate reimbursement for services rendered; includes functions such as insurance verfication/eligibility and preauthorization of services
Unassigned claim
Accounts receivable management
Electronic funds transfer
Encounter form
42. Person responsible for paying healthcare fees
Claims processing
Assignment of benefits
Guarantor
Deliquent claim
43. Series of fixed length records submitted to payers to bill for health care services.
Equal Credit Opportunity ACT
Delinquent claim cycle
Electronic media claim
Provider Remittance Notice
44. The insurance claim form used to report professional services
Litigation
Clearinghouse
CMS-1500
Fair Credit and Charge Card Disclosure ACT
45. System by which payers deposit funds to the providers account electronically.
Noncovered benefit
Electronic funds transfer
Unassigned claim
Fair Credit and Charge Card Disclosure ACT
46. Determines coverage by primary and secondary policies when each parent subscribes to a different health insurance plan.
Unauthorized service
Electronic media claim
Birthday rule
Superbill
47. Medical report substantiating a medical condition
ANSI ASC X12 standards
Electronic claim processing
Electronic funds transfer ACT
Claims attachment
48. 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.
Electronic funds transfer ACT
Accounts receivable aging report
Manual daily accounts receivable journal
Electronic remittance advi
49. The maximum amount a payer will reimburse for each procedure or service - according to the patient's policy.
Source document
Fair credit reporting Act
Allowed charges
Litigation
50. The provider receives reimbursement directly from the payer.
Unbundling
Assignment of benefits
Electronic data interchange EDI
Participating provider