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






2. Organization that accredits clearinghouses






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






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






5. 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.






6. Theperson eligible to receive healthcare benefits.






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






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






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






10. The insurance claim form used to report professional services






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






12. 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.






13. Person responsible for paying healthcare fees






14. 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;






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






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






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






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






19. 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.






20. A correctly completed standardized claim






21. 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






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






23. Contract out






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






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






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






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






28. A computerized permanent record of all financial transactions between the patient and the practice;also called patient account record.






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






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






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






32. 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.






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






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






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






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






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






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






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






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






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






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






43. 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






44. Computer to computer data exchange between payer and provider






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






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






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






48. 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






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






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