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






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






3. Form used to report institutional - facility services.






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






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






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






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






8. 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.






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






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. 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.






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






14. 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






15. 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






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






17. Theperson eligible to receive healthcare benefits.






18. The provider receives reimbursement directly from the payer.






19. 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






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






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






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






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






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






25. The amount owed to a business for services or goods provided






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






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






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






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






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






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






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






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






34. Contract out






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






36. Medical report substantiating a medical condition






37. 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.






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






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






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






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






42. 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






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






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






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






46. 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






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






48. 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;






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






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