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. 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






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






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






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






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






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






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






8. 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






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






10. 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;






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






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






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






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






15. 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.






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






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






18. Theperson eligible to receive healthcare benefits.






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






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






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






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






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






24. Computer to computer data exchange between payer and provider






25. 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






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






27. Person responsible for paying healthcare fees






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






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






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






31. The provider receives reimbursement directly from the payer.






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






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






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






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






36. A correctly completed standardized claim






37. 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.






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






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






40. Amended the Truth in Lending Act - requiring credit and charge card issuers to provide certain disclosures in direct mail - telephone - and any other application and solicitations for open-end credit and charge accounts and under other circumstances;






41. The insurance claim form used to report professional services






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






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






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






45. Medical report substantiating a medical condition






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






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






48. 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






49. 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.






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