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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. The transmission of claims data (electronical or manually) to payers or clearinghouses for processing.
Coordination of benefits (COB)
Unauthorized service
Two-party check
Claims submission
2. Any medical condition that was diagnosed and or treated within a specified period of time immediately preceding the enrollee's effective date of coverage.
Claims submission
Pre-existing condition
Day sheet
Beneficiary
3. The amount owed to a business for services or goods provided
Common data file
Accounts receivable
Delinquent account
Fair credit reporting Act
4. The provider receives reimbursement directly from the payer.
Assignment of benefits
Value-added network (VAN)
Manual daily accounts receivable journal
Electronic remittance advi
5. Is a public or private entity that processes of facilitates the processing of nonstandard data elements into standard data elements.
Past-due account
Noncovered benefit
Clearinghouse
Claims processing
6. Sorting claims upon submission to collect and verify information about a patient and provider.
Birthday rule
CMS-1500
Beneficiary
Claims processing
7. When the provider agrees to accept what the insurance company allows or aproves as payment in full for the claim
Clearinghouse
Electronic data interchange EDI
Claims attachment
Accept assignment
8. System by which payers deposit funds to the providers account electronically.
Electronic funds transfer
Claims processing
Equal Credit Opportunity ACT
Nonparticipating provider
9. 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.
Equal Credit Opportunity ACT
Fair Credit Billing Act
Guarantor
Noncovered benefit
10. Shows the status (by date) of outstanding claims from each payer - as well as payments due from patients
Manual daily accounts receivable journal
Consumer Credit Protection Act of 1968
Accounts receivable aging report
Unassigned claim
11. 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
Provider Remittance Notice
Manual daily accounts receivable journal
Consumer Credit Protection Act of 1968
Unbundling
12. Specifies what a collection source may or may not do when pursuing payment on past due accounts.
Fair debt collection practicies Act
Assignment of benefits
Deductible
Out-of-pocket payment
13. Submitted to the payer - but processing is not complete
Open claim
Electronic Healthcare Network Accreditation Commission EHNAC
Guarantor
Value-added network (VAN)
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;
Clearinghouse
Fair Credit and Charge Card Disclosure ACT
Electronic flat file format
Fair credit reporting Act
15. 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
Patient ledger
Fair Credit and Charge Card Disclosure ACT
Fair credit reporting Act
Electronic remittance advi
16. Contract out
Covered entity
Coordination of benefits (COB)
Outsourcing
Patient account record
17. Sending data in a standardized machine readable format to an insurance company via disk - telephone or cable.
Electronic claim processing
Electronic funds transfer
Patient account record
Claims attachment
18. One that has not been paid within a certain time frame; also called delinquent account
Past-due account
Deductible
UB-04
Fair Credit and Charge Card Disclosure ACT
19. Also called manual daily accounts receivable journal; cronological summary of all transactions posted to individual patient legers/accounts on a specific day.
ANSI ASC X12 standards
Claims adjudication
Day sheet
Two-party check
20. Computer to computer data exchange between payer and provider
Guarantor
Electronic data interchange EDI
Claims adjudication
Consumer Credit Protection Act of 1968
21. A computerized permanent record of all financial transactions between the patient and the practice;also called patient account record.
Patient ledger
Outsourcing
Equal Credit Opportunity ACT
Provider Remittance Notice
22. Financial record source document used by providers and other personnel to record treated diagnoses and services rendered to the patient during the current encounter.
Beneficiary
Encounter form
Litigation
Claims processing
23. 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
Outsourcing
Value-added network (VAN)
Patient ledger
Fair credit reporting Act
24. Amount for which the patient is financially responsible before an insurance company provides coverage.
Unauthorized service
Deductible
Covered entity
Source document
25. The percentage the patient pays for covered services after the deductible has been met and the copayment has been paid.
Fair debt collection practicies Act
Coinsurance
Superbill
Deductible
26. 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.
Day sheet
Claims processing
Open claim
Electronic remittance advi
27. Theperson eligible to receive healthcare benefits.
Fair debt collection practicies Act
Beneficiary
Coordination of benefits (COB)
Electronic media claim
28. Also called a day sheet - a chronological summary of all transactions posted to individual patient ledgers/accounts on a specific day.
Electronic claim processing
Manual daily accounts receivable journal
Source document
Electronic funds transfer ACT
29. Associated with how an insurance plan is billed-the insurance plan responsible for paying healthcare insurance claims first is considered primary.
Primary insurance
Open claim
Encounter form
Assignment of benefits
30. Form used to report institutional - facility services.
Consumer Credit Protection Act of 1968
Beneficiary
Fair Credit Billing Act
UB-04
31. Submitting multiple CPT codes when one code could of been submitted.
Unbundling
Source document
Accounts receivable management
Bad debt
32. 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.
Equal Credit Opportunity ACT
Out-of-pocket payment
Deliquent claim
Clean claim
33. Abstract of all recent claims filed on each patient.
Electronic remittance advi
Electronic media claim
Common data file
Two-party check
34. Term used for the encounter form in the physicians's office.
Outsourcing
Superbill
Coordination of benefits (COB)
Manual daily accounts receivable journal
35. A routing slip - charge slip - encounter form - or suberbill from which the insurance claim was generated.
Birthday rule
Source document
Coinsurance
Claims processing
36. Determines coverage by primary and secondary policies when each parent subscribes to a different health insurance plan.
Birthday rule
Accept assignment
Primary insurance
Fair Credit Billing Act
37. Services that are provided to a patient without proper authorization or that are not covered by a current authorization.
Unauthorized service
Birthday rule
Fair credit reporting Act
Electronic remittance advi
38. Uses a variable-length file format to process transactions for institutional - professional - dental - and drug claims.
Coinsurance
Two-party check
ANSI ASC X12 standards
Accounts receivable aging report
39. The insurance claim form used to report professional services
Chargemaster
UB-04
CMS-1500
Participating provider
40. Health plans - healthcare clearinghouses - government health plans - and any health providers that choose to submit or receive transactions electronically.
Outsourcing
Equal Credit Opportunity ACT
Covered entity
Beneficiary
41. A correctly completed standardized claim
Clean claim
Bad debt
Litigation
Electronic flat file format
42. 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)
Accept assignment
Coinsurance
Electronic media claim
43. The term hospitals use to describe the encounter form.
Day sheet
Fair credit reporting Act
Unassigned claim
Chargemaster
44. Person responsible for paying healthcare fees
Guarantor
Assignment of benefits
Delinquent claim cycle
Superbill
45. Remittance advice submitted by Medicare to providers that includes payment information about a claim.
Fair Credit Billing Act
Clearinghouse
Patient ledger
Provider Remittance Notice
46. Is a past due account; one that has not been paid within a certain time frame.
Delinquent account
Provider Remittance Notice
Electronic remittance advi
Coinsurance
47. Does not contract with the insurance plan; patient who elects to recieve care from nonPARS will incur higher out-of-pocket expenses.
Nonparticipating provider
Equal Credit Opportunity ACT
Beneficiary
Closed claim
48. Accounts receivable that cannot be collected by the provider or a collect agency.
Coinsurance
Nonparticipating provider
Electronic flat file format
Bad debt
49. Claims for which all processing - including appeals - has been completed.
Closed claim
Accounts receivable aging report
Claims processing
Unassigned claim
50. Assigning lower-level codes then documented in the record.
Guarantor
Fair Credit Billing Act
Downcoding
Delinquent account