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. The provider receives reimbursement directly from the payer.






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






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






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






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






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






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






8. Form used to report institutional - facility services.






9. The insurance claim form used to report professional services






10. Also called a day sheet - a chronological summary of all transactions posted to individual patient ledgers/accounts on a specific day.






11. 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.






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






13. Person responsible for paying healthcare fees






14. 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.






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






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






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






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






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






20. 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.






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






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






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






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






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






26. Organization that accredits clearinghouses






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






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






29. Medical report substantiating a medical condition






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






31. Theperson eligible to receive healthcare benefits.






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






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






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






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






36. 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






37. 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.






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






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






40. 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






41. 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;






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






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






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






45. Computer to computer data exchange between payer and provider






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






47. 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






48. A correctly completed standardized claim






49. Contract out






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