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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. Establishes the rights. liabilites - and rsponsibilities of participants in electronic funds transfer systems.
Noncovered benefit
Electronic Healthcare Network Accreditation Commission EHNAC
Electronic funds transfer ACT
Manual daily accounts receivable journal
2. Submitted to the payer - but processing is not complete
Out-of-pocket payment
Open claim
Fair Credit Billing Act
Accept assignment
3. The maximum amount a payer will reimburse for each procedure or service - according to the patient's policy.
Allowed charges
Claims submission
Fair Credit and Charge Card Disclosure ACT
Participating provider
4. Also called a day sheet - a chronological summary of all transactions posted to individual patient ledgers/accounts on a specific day.
Chargemaster
Assignment of benefits
Manual daily accounts receivable journal
CMS-1500
5. Uses a variable-length file format to process transactions for institutional - professional - dental - and drug claims.
Claims submission
Assignment of benefits
Claims adjudication
ANSI ASC X12 standards
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
Clean claim
Electronic flat file format
Patient ledger
Consumer Credit Protection Act of 1968
7. The insurance claim form used to report professional services
Primary insurance
Equal Credit Opportunity ACT
Accounts receivable
CMS-1500
8. A correctly completed standardized claim
Clearinghouse
Two-party check
Patient ledger
Clean claim
9. Advances through various aging periods( 30 -60 -90 -120) with practices typically focusing internal recovery efforts on older delinquent accounts.
Participating provider
Delinquent claim cycle
Patient ledger
Superbill
10. Computer to computer data exchange between payer and provider
Electronic flat file format
Electronic data interchange EDI
Guarantor
Deductible
11. Theperson eligible to receive healthcare benefits.
Delinquent account
Beneficiary
Clean claim
Electronic Healthcare Network Accreditation Commission EHNAC
12. Shows the status (by date) of outstanding claims from each payer - as well as payments due from patients
Superbill
Clearinghouse
Accounts receivable aging report
Deductible
13. When the provider agrees to accept what the insurance company allows or aproves as payment in full for the claim
Patient account record
Accept assignment
Beneficiary
Electronic media claim
14. Does not contract with the insurance plan; patient who elects to recieve care from nonPARS will incur higher out-of-pocket expenses.
Nonparticipating provider
Electronic data interchange EDI
Past-due account
Value-added network (VAN)
15. Services that are provided to a patient without proper authorization or that are not covered by a current authorization.
Electronic claim processing
Claims submission
Unauthorized service
Nonparticipating provider
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;
Guarantor
Consumer Credit Protection Act of 1968
Fair Credit Billing Act
Day sheet
17. Series of fixed length records submitted to payers to bill for health care services.
Accept assignment
Unbundling
Electronic media claim
Pre-existing condition
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;
Source document
Claims submission
Fair Credit and Charge Card Disclosure ACT
Consumer Credit Protection Act of 1968
19. Organization that accredits clearinghouses
Fair Credit Billing Act
Pre-existing condition
Electronic Healthcare Network Accreditation Commission EHNAC
Claims submission
20. Series of fixed length records submitted to payers to bill for health care services.
Claims adjudication
Electronic flat file format
Accounts receivable management
Fair credit reporting Act
21. Also called manual daily accounts receivable journal; cronological summary of all transactions posted to individual patient legers/accounts on a specific day.
Delinquent claim cycle
Fair Credit and Charge Card Disclosure ACT
Consumer Credit Protection Act of 1968
Day sheet
22. A computerized permanent record of all financial transactions between the patient and the pratice - also called patient ledger.
Assignment of benefits
Value-added network (VAN)
Patient account record
Clearinghouse
23. Amount for which the patient is financially responsible before an insurance company provides coverage.
Unauthorized service
CMS-1500
Unassigned claim
Deductible
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
Accounts receivable aging report
Common data file
Encounter form
Value-added network (VAN)
25. The provider receives reimbursement directly from the payer.
Electronic flat file format
Open claim
Fair debt collection practicies Act
Assignment of benefits
26. Claims for which all processing - including appeals - has been completed.
Closed claim
Provider Remittance Notice
Unbundling
Claims adjudication
27. A computerized permanent record of all financial transactions between the patient and the practice;also called patient account record.
Source document
Out-of-pocket payment
Patient ledger
Claims processing
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.
Accept assignment
Encounter form
Accounts receivable aging report
Delinquent claim cycle
29. Submitting multiple CPT codes when one code could of been submitted.
Delinquent claim cycle
Unbundling
Chargemaster
Common data file
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.
Electronic remittance advi
Value-added network (VAN)
Superbill
Electronic claim processing
31. A claim that is usually more than 120 days past due; some practices establish time frames that are less than 120 days.
Past-due account
Deliquent claim
Participating provider
Noncovered benefit
32. Accounts receivable that cannot be collected by the provider or a collect agency.
Electronic funds transfer
Bad debt
Claims submission
Noncovered benefit
33. Contracts with a helath insurance plan and accepts whatever the plan pays for procedures or services performed.
ANSI ASC X12 standards
Source document
Out-of-pocket payment
Participating provider
34. Specifies what a collection source may or may not do when pursuing payment on past due accounts.
Participating provider
Deductible
Accounts receivable
Fair debt collection practicies Act
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
Electronic funds transfer ACT
Unassigned claim
Fair Credit and Charge Card Disclosure ACT
Fair credit reporting Act
36. Sorting claims upon submission to collect and verify information about a patient and provider.
Coinsurance
Claims processing
Common data file
Accounts receivable management
37. Sending data in a standardized machine readable format to an insurance company via disk - telephone or cable.
Electronic claim processing
Accounts receivable aging report
Fair Credit and Charge Card Disclosure ACT
Closed claim
38. Associated with how an insurance plan is billed-the insurance plan responsible for paying healthcare insurance claims first is considered primary.
Primary insurance
Fair Credit Billing Act
Accept assignment
Fair credit reporting Act
39. Assigning lower-level codes then documented in the record.
Claims adjudication
Noncovered benefit
Assignment of benefits
Downcoding
40. The term hospitals use to describe the encounter form.
Electronic Healthcare Network Accreditation Commission EHNAC
Open claim
Electronic funds transfer
Chargemaster
41. Legal action to recover a debt; usually a last resort for a medical practice.
Electronic funds transfer ACT
Equal Credit Opportunity ACT
Litigation
Claims adjudication
42. Abstract of all recent claims filed on each patient.
Claims adjudication
Manual daily accounts receivable journal
Common data file
Electronic flat file format
43. Person responsible for paying healthcare fees
Downcoding
Guarantor
Common data file
Primary insurance
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
Out-of-pocket payment
Day sheet
Allowed charges
Value-added network (VAN)
45. Determines coverage by primary and secondary policies when each parent subscribes to a different health insurance plan.
Birthday rule
Accounts receivable aging report
Claims adjudication
Allowed charges
46. Term used for the encounter form in the physicians's office.
Superbill
Outsourcing
Patient ledger
Open claim
47. Is a past due account; one that has not been paid within a certain time frame.
Encounter form
Electronic claim processing
Delinquent account
Birthday rule
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.
Equal Credit Opportunity ACT
Fair Credit Billing Act
Fair Credit and Charge Card Disclosure ACT
Coinsurance
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.
Consumer Credit Protection Act of 1968
Patient ledger
Electronic funds transfer
Noncovered benefit
50. One that has not been paid within a certain time frame; also called delinquent account
Past-due account
Deliquent claim
Consumer Credit Protection Act of 1968
Coordination of benefits (COB)