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






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






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






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






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






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






7. 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.






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






9. 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.






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






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






12. The provider receives reimbursement directly from the payer.






13. Computer to computer data exchange between payer and provider






14. 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.






15. 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.






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






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






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






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






20. 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;






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






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






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






24. Organization that accredits clearinghouses






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






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. 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






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






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






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






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






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






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






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






35. Contract out






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






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






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






39. Medical report substantiating a medical condition






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






41. Theperson eligible to receive healthcare benefits.






42. A correctly completed standardized claim






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






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






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






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






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






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






49. 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






50. Form used to report institutional - facility services.