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






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






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






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






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






6. 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






7. The insurance claim form used to report professional services






8. A correctly completed standardized claim






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






10. Computer to computer data exchange between payer and provider






11. Theperson eligible to receive healthcare benefits.






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






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






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






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






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;






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






18. 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;






19. Organization that accredits clearinghouses






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






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






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






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






24. 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






25. The provider receives reimbursement directly from the payer.






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






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






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






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






30. 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.






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






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






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






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






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






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






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






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






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






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






43. Person responsible for paying healthcare fees






44. 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






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






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






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






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. 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.






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