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






2. Contract out






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






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






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






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






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






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






9. 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






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






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






12. 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;






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






14. Medical report substantiating a medical condition






15. 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.






16. Organization that accredits clearinghouses






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






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






19. 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






20. 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






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






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






23. The provider receives reimbursement directly from the payer.






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






25. 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;






26. 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.






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






28. A correctly completed standardized claim






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






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






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






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






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






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






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






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






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






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






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.






40. 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






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






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






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






44. 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.






45. Form used to report institutional - facility services.






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






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






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






49. Person responsible for paying healthcare fees






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