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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 amount owed to a business for services or goods provided






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






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






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






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






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






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






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






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






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






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






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






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






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






15. Organization that accredits clearinghouses






16. 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.






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






18. 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






19. Computer to computer data exchange between payer and provider






20. 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.






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






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






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






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






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






26. 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






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






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






29. 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.






30. 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






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






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






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






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






35. 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.






36. A correctly completed standardized claim






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






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






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






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






41. Contract out






42. 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






43. 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;






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






45. Person responsible for paying healthcare fees






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






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






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






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






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







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