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






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






3. Medical report substantiating a medical condition






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






5. The provider receives reimbursement directly from the payer.






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






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






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






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






10. 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.






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






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






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






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






15. 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






16. Organization that accredits clearinghouses






17. 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






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






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






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






21. Theperson eligible to receive healthcare benefits.






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






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






24. Contract out






25. 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.






26. A correctly completed standardized claim






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






28. 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;






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






30. 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






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






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






33. 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.






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






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






36. 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






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






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






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






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






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






42. 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.






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






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






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






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






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






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






49. 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






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