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Test your basic knowledge |
Health Insurance
Start Test
Study First
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. 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.
Closed claim
Chargemaster
UB-04
Equal Credit Opportunity ACT
2. Form used to report institutional - facility services.
UB-04
Fair debt collection practicies Act
CMS-1500
Electronic media claim
3. 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
Allowed charges
Out-of-pocket payment
Encounter form
CMS-1500
4. The maximum amount a payer will reimburse for each procedure or service - according to the patient's policy.
Coinsurance
Fair Credit Billing Act
Allowed charges
Electronic flat file format
5. Claims for which all processing - including appeals - has been completed.
Allowed charges
Closed claim
Provider Remittance Notice
UB-04
6. Also called manual daily accounts receivable journal; cronological summary of all transactions posted to individual patient legers/accounts on a specific day.
UB-04
Guarantor
Primary insurance
Day sheet
7. Associated with how an insurance plan is billed-the insurance plan responsible for paying healthcare insurance claims first is considered primary.
Patient ledger
Electronic remittance advi
Electronic funds transfer ACT
Primary insurance
8. Abstract of all recent claims filed on each patient.
Manual daily accounts receivable journal
Assignment of benefits
Clean claim
Common data file
9. A check made out to the patient and the provider.
Two-party check
CMS-1500
Primary insurance
Allowed charges
10. The term hospitals use to describe the encounter form.
Chargemaster
Guarantor
Assignment of benefits
Electronic claim processing
11. The insurance claim form used to report professional services
Fair Credit Billing Act
Coordination of benefits (COB)
Accounts receivable aging report
CMS-1500
12. 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
Provider Remittance Notice
Electronic media claim
Consumer Credit Protection Act of 1968
Claims adjudication
13. Determines coverage by primary and secondary policies when each parent subscribes to a different health insurance plan.
Unauthorized service
Birthday rule
Open claim
Accounts receivable aging report
14. Contract out
Out-of-pocket payment
Outsourcing
Patient ledger
Clearinghouse
15. Does not contract with the insurance plan; patient who elects to recieve care from nonPARS will incur higher out-of-pocket expenses.
Accept assignment
Electronic data interchange EDI
Accounts receivable
Nonparticipating provider
16. Person responsible for paying healthcare fees
Claims adjudication
Beneficiary
Unbundling
Guarantor
17. 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.
Noncovered benefit
Fair debt collection practicies Act
Patient ledger
Electronic funds transfer ACT
18. 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;
Fair Credit Billing Act
Electronic data interchange EDI
Past-due account
Outsourcing
19. System by which payers deposit funds to the providers account electronically.
Manual daily accounts receivable journal
Patient account record
Electronic funds transfer
Superbill
20. The transmission of claims data (electronical or manually) to payers or clearinghouses for processing.
Electronic flat file format
Day sheet
Claims submission
Delinquent claim cycle
21. 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.
Electronic claim processing
Coordination of benefits (COB)
Delinquent account
Beneficiary
22. Submitted to the payer - but processing is not complete
Claims submission
Nonparticipating provider
Open claim
Unbundling
23. Sending data in a standardized machine readable format to an insurance company via disk - telephone or cable.
Clearinghouse
Patient ledger
Electronic media claim
Electronic claim processing
24. Assigning lower-level codes then documented in the record.
Claims submission
Unauthorized service
Delinquent account
Downcoding
25. A correctly completed standardized claim
Clean claim
Source document
Claims submission
UB-04
26. When the provider agrees to accept what the insurance company allows or aproves as payment in full for the claim
Accept assignment
Patient account record
Clearinghouse
Out-of-pocket payment
27. Financial record source document used by providers and other personnel to record treated diagnoses and services rendered to the patient during the current encounter.
Patient ledger
Encounter form
Accept assignment
Claims attachment
28. Remittance advice submitted by Medicare to providers that includes payment information about a claim.
Electronic funds transfer ACT
Patient ledger
Provider Remittance Notice
Clean claim
29. The provider receives reimbursement directly from the payer.
Birthday rule
Out-of-pocket payment
Electronic media claim
Assignment of benefits
30. Medical report substantiating a medical condition
Deliquent claim
Claims attachment
CMS-1500
Consumer Credit Protection Act of 1968
31. Is a past due account; one that has not been paid within a certain time frame.
Delinquent account
Pre-existing condition
Value-added network (VAN)
Assignment of benefits
32. Shows the status (by date) of outstanding claims from each payer - as well as payments due from patients
Birthday rule
Pre-existing condition
Delinquent claim cycle
Accounts receivable aging report
33. Uses a variable-length file format to process transactions for institutional - professional - dental - and drug claims.
Superbill
ANSI ASC X12 standards
Encounter form
Electronic funds transfer
34. Assists providers in the collection of appropriate reimbursement for services rendered; includes functions such as insurance verfication/eligibility and preauthorization of services
Clean claim
Outsourcing
Participating provider
Accounts receivable management
35. Organization that accredits clearinghouses
Electronic Healthcare Network Accreditation Commission EHNAC
Accounts receivable aging report
Delinquent account
Claims processing
36. Accounts receivable that cannot be collected by the provider or a collect agency.
Open claim
Unauthorized service
Claims submission
Bad debt
37. Theperson eligible to receive healthcare benefits.
Allowed charges
Accounts receivable aging report
Superbill
Beneficiary
38. 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
Out-of-pocket payment
Delinquent claim cycle
Pre-existing condition
Fair credit reporting Act
39. Services that are provided to a patient without proper authorization or that are not covered by a current authorization.
Litigation
Coinsurance
Unauthorized service
Out-of-pocket payment
40. A claim that is usually more than 120 days past due; some practices establish time frames that are less than 120 days.
Clean claim
Deliquent claim
Chargemaster
Litigation
41. A computerized permanent record of all financial transactions between the patient and the practice;also called patient account record.
Patient ledger
Assignment of benefits
Unassigned claim
Common data file
42. Advances through various aging periods( 30 -60 -90 -120) with practices typically focusing internal recovery efforts on older delinquent accounts.
Bad debt
UB-04
Delinquent claim cycle
Closed claim
43. Also called a day sheet - a chronological summary of all transactions posted to individual patient ledgers/accounts on a specific day.
Unassigned claim
Guarantor
Manual daily accounts receivable journal
Past-due account
44. One that has not been paid within a certain time frame; also called delinquent account
Coordination of benefits (COB)
Past-due account
Electronic funds transfer
Superbill
45. Legal action to recover a debt; usually a last resort for a medical practice.
Claims processing
Litigation
Electronic funds transfer
Delinquent claim cycle
46. Series of fixed length records submitted to payers to bill for health care services.
Birthday rule
Source document
Deductible
Electronic media claim
47. 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.
Birthday rule
Electronic remittance advi
Unassigned claim
Patient account record
48. Establishes the rights. liabilites - and rsponsibilities of participants in electronic funds transfer systems.
Beneficiary
Patient ledger
Electronic funds transfer ACT
Manual daily accounts receivable journal
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
Value-added network (VAN)
Fair Credit Billing Act
Primary insurance
Fair Credit and Charge Card Disclosure ACT
50. Submitting multiple CPT codes when one code could of been submitted.
Noncovered benefit
Unbundling
Allowed charges
Beneficiary