SUBJECTS
|
BROWSE
|
CAREER CENTER
|
POPULAR
|
JOIN
|
LOGIN
Business Skills
|
Soft Skills
|
Basic Literacy
|
Certifications
About
|
Help
|
Privacy
|
Terms
Search
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. Shows the status (by date) of outstanding claims from each payer - as well as payments due from patients
Accounts receivable aging report
Source document
ANSI ASC X12 standards
Value-added network (VAN)
2. When the provider agrees to accept what the insurance company allows or aproves as payment in full for the claim
Equal Credit Opportunity ACT
Allowed charges
Patient ledger
Accept assignment
3. Series of fixed length records submitted to payers to bill for health care services.
Participating provider
Electronic flat file format
Manual daily accounts receivable journal
Coordination of benefits (COB)
4. The provider receives reimbursement directly from the payer.
Electronic Healthcare Network Accreditation Commission EHNAC
Unassigned claim
Covered entity
Assignment of benefits
5. 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.
Claims processing
Value-added network (VAN)
Consumer Credit Protection Act of 1968
Noncovered benefit
6. Computer to computer data exchange between payer and provider
ANSI ASC X12 standards
Unauthorized service
Fair credit reporting Act
Electronic data interchange EDI
7. 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
Out-of-pocket payment
Outsourcing
Participating provider
Primary insurance
8. A routing slip - charge slip - encounter form - or suberbill from which the insurance claim was generated.
CMS-1500
Superbill
Source document
Consumer Credit Protection Act of 1968
9. Assigning lower-level codes then documented in the record.
Superbill
Electronic media claim
Litigation
Downcoding
10. 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
Birthday rule
Electronic funds transfer ACT
Claims adjudication
Claims processing
11. Any medical condition that was diagnosed and or treated within a specified period of time immediately preceding the enrollee's effective date of coverage.
Accounts receivable aging report
Out-of-pocket payment
Pre-existing condition
Deliquent claim
12. The percentage the patient pays for covered services after the deductible has been met and the copayment has been paid.
Primary insurance
Coinsurance
Electronic remittance advi
Allowed charges
13. One that has not been paid within a certain time frame; also called delinquent account
Deductible
Source document
Past-due account
Fair Credit Billing Act
14. A correctly completed standardized claim
Open claim
Fair Credit and Charge Card Disclosure ACT
Clean claim
Allowed charges
15. Is a public or private entity that processes of facilitates the processing of nonstandard data elements into standard data elements.
Electronic flat file format
Clearinghouse
Fair credit reporting Act
Allowed charges
16. Form used to report institutional - facility services.
UB-04
Assignment of benefits
Clearinghouse
Electronic claim processing
17. 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.
Beneficiary
Unassigned claim
Equal Credit Opportunity ACT
ANSI ASC X12 standards
18. Abstract of all recent claims filed on each patient.
Common data file
Electronic funds transfer
Pre-existing condition
ANSI ASC X12 standards
19. Is a past due account; one that has not been paid within a certain time frame.
Fair credit reporting Act
Accept assignment
Claims submission
Delinquent account
20. Legal action to recover a debt; usually a last resort for a medical practice.
Patient account record
Litigation
Coordination of benefits (COB)
Claims processing
21. The term hospitals use to describe the encounter form.
Chargemaster
Guarantor
Clearinghouse
Encounter form
22. Services that are provided to a patient without proper authorization or that are not covered by a current authorization.
Coinsurance
Unbundling
Two-party check
Unauthorized service
23. Sorting claims upon submission to collect and verify information about a patient and provider.
Accounts receivable aging report
UB-04
Claims processing
Litigation
24. Theperson eligible to receive healthcare benefits.
Outsourcing
Unauthorized service
Beneficiary
UB-04
25. Remittance advice submitted by Medicare to providers that includes payment information about a claim.
Assignment of benefits
Clean claim
Beneficiary
Provider Remittance Notice
26. Term used for the encounter form in the physicians's office.
Electronic Healthcare Network Accreditation Commission EHNAC
Fair debt collection practicies Act
Superbill
Fair Credit Billing Act
27. Assists providers in the collection of appropriate reimbursement for services rendered; includes functions such as insurance verfication/eligibility and preauthorization of services
Past-due account
Accounts receivable management
UB-04
Noncovered benefit
28. Financial record source document used by providers and other personnel to record treated diagnoses and services rendered to the patient during the current encounter.
Encounter form
Open claim
Accounts receivable management
Electronic media claim
29. Series of fixed length records submitted to payers to bill for health care services.
Assignment of benefits
Electronic media claim
Common data file
Source document
30. Establishes the rights. liabilites - and rsponsibilities of participants in electronic funds transfer systems.
Patient ledger
Electronic funds transfer ACT
Electronic data interchange EDI
Litigation
31. 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;
Claims processing
Superbill
Fair Credit and Charge Card Disclosure ACT
Fair credit reporting Act
32. Also called manual daily accounts receivable journal; cronological summary of all transactions posted to individual patient legers/accounts on a specific day.
Superbill
Electronic Healthcare Network Accreditation Commission EHNAC
Day sheet
Clean claim
33. Health plans - healthcare clearinghouses - government health plans - and any health providers that choose to submit or receive transactions electronically.
Accounts receivable aging report
Participating provider
Covered entity
Pre-existing condition
34. Contracts with a helath insurance plan and accepts whatever the plan pays for procedures or services performed.
Delinquent claim cycle
Fair debt collection practicies Act
Fair Credit and Charge Card Disclosure ACT
Participating provider
35. Determines coverage by primary and secondary policies when each parent subscribes to a different health insurance plan.
Coinsurance
Birthday rule
Covered entity
Primary insurance
36. Accounts receivable that cannot be collected by the provider or a collect agency.
Source document
Bad debt
UB-04
Deductible
37. 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
Noncovered benefit
Delinquent account
Downcoding
Value-added network (VAN)
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
Accounts receivable management
Coordination of benefits (COB)
Fair credit reporting Act
Source document
39. 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.
Electronic remittance advi
Nonparticipating provider
Litigation
UB-04
40. 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.
Unassigned claim
Deductible
Equal Credit Opportunity ACT
Consumer Credit Protection Act of 1968
41. Organization that accredits clearinghouses
Electronic Healthcare Network Accreditation Commission EHNAC
Accounts receivable aging report
Electronic funds transfer
Fair Credit and Charge Card Disclosure ACT
42. The insurance claim form used to report professional services
Patient ledger
CMS-1500
Electronic data interchange EDI
Equal Credit Opportunity ACT
43. Submitted to the payer - but processing is not complete
CMS-1500
Unauthorized service
Open claim
Day sheet
44. Claims for which all processing - including appeals - has been completed.
Bad debt
Fair Credit Billing Act
Electronic Healthcare Network Accreditation Commission EHNAC
Closed claim
45. Person responsible for paying healthcare fees
Guarantor
Primary insurance
Electronic media claim
Nonparticipating provider
46. A computerized permanent record of all financial transactions between the patient and the practice;also called patient account record.
Patient ledger
Consumer Credit Protection Act of 1968
Claims processing
Clean claim
47. 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.
Coordination of benefits (COB)
Two-party check
Closed claim
Allowed charges
48. 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;
Electronic flat file format
Fair Credit Billing Act
Bad debt
Beneficiary
49. A computerized permanent record of all financial transactions between the patient and the pratice - also called patient ledger.
Equal Credit Opportunity ACT
Unassigned claim
Coinsurance
Patient account record
50. The transmission of claims data (electronical or manually) to payers or clearinghouses for processing.
Manual daily accounts receivable journal
Claims submission
Common data file
Downcoding