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






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






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






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






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.






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






7. 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;






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






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






10. Theperson eligible to receive healthcare benefits.






11. Contract out






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






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






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






15. 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.






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






17. The provider receives reimbursement directly from the payer.






18. Person responsible for paying healthcare fees






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






20. 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






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






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






23. 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






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






25. Form used to report institutional - facility services.






26. A correctly completed standardized claim






27. 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






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






29. Medical report substantiating a medical condition






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






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






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






33. Computer to computer data exchange between payer and provider






34. 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.






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






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






37. The insurance claim form used to report professional services






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






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






40. 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.






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






42. 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






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






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






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






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






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






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






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






50. 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;