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






2. Theperson eligible to receive healthcare benefits.






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






4. The insurance claim form used to report professional services






5. Person responsible for paying healthcare fees






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






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






8. 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;






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






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






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






12. 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






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






14. 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






15. The provider receives reimbursement directly from the payer.






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






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






18. 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.






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






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






21. Contract out






22. A correctly completed standardized claim






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






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






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






26. 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.






27. 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






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






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






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






31. Computer to computer data exchange between payer and provider






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






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






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






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






36. 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.






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






38. 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.






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






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






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






42. Medical report substantiating a medical condition






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






44. Form used to report institutional - facility services.






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






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






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






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






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






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