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






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






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






4. 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






5. Person responsible for paying healthcare fees






6. Contract out






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






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






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






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






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






12. A correctly completed standardized claim






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






14. Form used to report institutional - facility services.






15. 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






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






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






18. 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.






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






20. 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






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






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






23. 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.






24. Medical report substantiating a medical condition






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






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






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






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






29. 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;






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






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






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






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






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






35. 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.






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






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






38. 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.






39. Organization that accredits clearinghouses






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






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






42. 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






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






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






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






46. 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






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






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






49. The provider receives reimbursement directly from the payer.






50. Theperson eligible to receive healthcare benefits.