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






2. The provider receives reimbursement directly from the payer.






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






4. 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






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






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






7. 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






8. 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.






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






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






11. 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;






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






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






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






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






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






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






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






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






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






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






22. 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.






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






24. Contract out






25. Person responsible for paying healthcare fees






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






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






28. Computer to computer data exchange between payer and provider






29. The insurance claim form used to report professional services






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






31. Medical report substantiating a medical condition






32. 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






33. Form used to report institutional - facility services.






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






35. Organization that accredits clearinghouses






36. Are organized by year; generated for providers who do not accept assignment; includes all unassigned claims for which the provider is not obligated to perform any follow-up work.






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






38. Theperson eligible to receive healthcare benefits.






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






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






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






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






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






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






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






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






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






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






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






50. 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;






Can you answer 50 questions in 15 minutes?



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