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






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






3. Form used to report institutional - facility services.






4. Computer to computer data exchange between payer and provider






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






6. 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






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






8. 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






9. The insurance claim form used to report professional services






10. 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






11. The provider receives reimbursement directly from the payer.






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






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






14. 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.






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






16. Person responsible for paying healthcare fees






17. Medical report substantiating a medical condition






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






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






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






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






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






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






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






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






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






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






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






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






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






31. 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.






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






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






34. Contract out






35. Theperson eligible to receive healthcare benefits.






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






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






38. 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






39. 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;






40. 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.






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






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






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






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






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






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






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






48. Organization that accredits clearinghouses






49. A correctly completed standardized claim






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