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. The provider receives reimbursement directly from the payer.






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






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






4. Contract out






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






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






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






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






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






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






11. 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.






12. 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;






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






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






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






16. 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






17. Theperson eligible to receive healthcare benefits.






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






19. 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.






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






21. Computer to computer data exchange between payer and provider






22. 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






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






24. The insurance claim form used to report professional services






25. Medical report substantiating a medical condition






26. 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;






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






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






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






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






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






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






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






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






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






37. Person responsible for paying healthcare fees






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






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






40. 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.






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






42. 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






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






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






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






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






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






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






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