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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. A check made out to the patient and the provider.
Patient account record
Deliquent claim
Two-party check
Primary insurance
2. 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
Fair debt collection practicies Act
Consumer Credit Protection Act of 1968
Birthday rule
Pre-existing condition
3. Is a public or private entity that processes of facilitates the processing of nonstandard data elements into standard data elements.
Outsourcing
Clearinghouse
Litigation
Beneficiary
4. A correctly completed standardized claim
Equal Credit Opportunity ACT
Claims submission
Accounts receivable management
Clean claim
5. 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.
Chargemaster
Clearinghouse
Unassigned claim
ANSI ASC X12 standards
6. 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
Nonparticipating provider
Superbill
Out-of-pocket payment
Fair credit reporting Act
7. Any medical condition that was diagnosed and or treated within a specified period of time immediately preceding the enrollee's effective date of coverage.
Clean claim
Superbill
Deductible
Pre-existing condition
8. The transmission of claims data (electronical or manually) to payers or clearinghouses for processing.
Litigation
Claims adjudication
Downcoding
Claims submission
9. Financial record source document used by providers and other personnel to record treated diagnoses and services rendered to the patient during the current encounter.
Encounter form
Electronic funds transfer ACT
Accounts receivable
Source document
10. Accounts receivable that cannot be collected by the provider or a collect agency.
Claims adjudication
Bad debt
Fair credit reporting Act
Litigation
11. A computerized permanent record of all financial transactions between the patient and the pratice - also called patient ledger.
Encounter form
Patient account record
Accounts receivable aging report
Electronic claim processing
12. When the provider agrees to accept what the insurance company allows or aproves as payment in full for the claim
Accept assignment
Delinquent account
Source document
Birthday rule
13. Sending data in a standardized machine readable format to an insurance company via disk - telephone or cable.
Claims processing
Past-due account
Outsourcing
Electronic claim processing
14. 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
Electronic flat file format
Closed claim
Value-added network (VAN)
Accounts receivable
15. Shows the status (by date) of outstanding claims from each payer - as well as payments due from patients
Accounts receivable aging report
ANSI ASC X12 standards
Electronic funds transfer ACT
Electronic funds transfer
16. Services that are provided to a patient without proper authorization or that are not covered by a current authorization.
Birthday rule
Coinsurance
Manual daily accounts receivable journal
Unauthorized service
17. Theperson eligible to receive healthcare benefits.
Consumer Credit Protection Act of 1968
Allowed charges
Electronic remittance advi
Beneficiary
18. Contracts with a helath insurance plan and accepts whatever the plan pays for procedures or services performed.
Open claim
Fair Credit and Charge Card Disclosure ACT
Participating provider
Clean claim
19. Associated with how an insurance plan is billed-the insurance plan responsible for paying healthcare insurance claims first is considered primary.
Deductible
Electronic Healthcare Network Accreditation Commission EHNAC
Electronic media claim
Primary insurance
20. System by which payers deposit funds to the providers account electronically.
Manual daily accounts receivable journal
Day sheet
Pre-existing condition
Electronic funds transfer
21. Term used for the encounter form in the physicians's office.
Electronic data interchange EDI
Superbill
Assignment of benefits
Source document
22. Remittance advice submitted by Medicare to providers that includes payment information about a claim.
Delinquent claim cycle
Nonparticipating provider
Provider Remittance Notice
Guarantor
23. Abstract of all recent claims filed on each patient.
Covered entity
Common data file
Chargemaster
Past-due account
24. 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;
Electronic media claim
Allowed charges
Fair Credit and Charge Card Disclosure ACT
Primary insurance
25. Assigning lower-level codes then documented in the record.
Fair Credit and Charge Card Disclosure ACT
Downcoding
Superbill
Coinsurance
26. 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
Claims submission
Claims adjudication
Accounts receivable
Pre-existing condition
27. Computer to computer data exchange between payer and provider
Pre-existing condition
Electronic data interchange EDI
Electronic flat file format
Accounts receivable
28. Organization that accredits clearinghouses
Electronic Healthcare Network Accreditation Commission EHNAC
Litigation
Fair debt collection practicies Act
Noncovered benefit
29. Does not contract with the insurance plan; patient who elects to recieve care from nonPARS will incur higher out-of-pocket expenses.
Nonparticipating provider
Accounts receivable management
Fair Credit and Charge Card Disclosure ACT
Accounts receivable aging report
30. Health plans - healthcare clearinghouses - government health plans - and any health providers that choose to submit or receive transactions electronically.
Covered entity
Fair credit reporting Act
Closed claim
Deliquent claim
31. Advances through various aging periods( 30 -60 -90 -120) with practices typically focusing internal recovery efforts on older delinquent accounts.
Deductible
Birthday rule
Delinquent claim cycle
Electronic media claim
32. Also called a day sheet - a chronological summary of all transactions posted to individual patient ledgers/accounts on a specific day.
Manual daily accounts receivable journal
Patient account record
Electronic funds transfer
Unbundling
33. 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.
Clearinghouse
Outsourcing
Electronic remittance advi
Fair Credit Billing Act
34. Series of fixed length records submitted to payers to bill for health care services.
Claims processing
Litigation
Coinsurance
Electronic media claim
35. Specifies what a collection source may or may not do when pursuing payment on past due accounts.
Outsourcing
Pre-existing condition
Encounter form
Fair debt collection practicies Act
36. Medical report substantiating a medical condition
Electronic media claim
Claims attachment
Out-of-pocket payment
Pre-existing condition
37. The percentage the patient pays for covered services after the deductible has been met and the copayment has been paid.
Electronic data interchange EDI
Downcoding
Manual daily accounts receivable journal
Coinsurance
38. Amount for which the patient is financially responsible before an insurance company provides coverage.
Patient account record
Electronic remittance advi
Claims submission
Deductible
39. The insurance claim form used to report professional services
UB-04
CMS-1500
Electronic funds transfer
Claims processing
40. A computerized permanent record of all financial transactions between the patient and the practice;also called patient account record.
Value-added network (VAN)
Claims processing
Patient account record
Patient ledger
41. Assists providers in the collection of appropriate reimbursement for services rendered; includes functions such as insurance verfication/eligibility and preauthorization of services
UB-04
Accounts receivable management
Claims processing
Beneficiary
42. 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.
Clean claim
Electronic data interchange EDI
Equal Credit Opportunity ACT
Coinsurance
43. Is a past due account; one that has not been paid within a certain time frame.
Accounts receivable
Electronic funds transfer
Clearinghouse
Delinquent account
44. A claim that is usually more than 120 days past due; some practices establish time frames that are less than 120 days.
Claims adjudication
Encounter form
Electronic Healthcare Network Accreditation Commission EHNAC
Deliquent claim
45. 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;
Fair Credit Billing Act
Nonparticipating provider
Electronic remittance advi
Clearinghouse
46. Person responsible for paying healthcare fees
Open claim
Equal Credit Opportunity ACT
Common data file
Guarantor
47. Contract out
Outsourcing
Fair Credit Billing Act
Unbundling
Clean claim
48. The provider receives reimbursement directly from the payer.
Coinsurance
Assignment of benefits
Past-due account
Electronic flat file format
49. Sorting claims upon submission to collect and verify information about a patient and provider.
Claims processing
Noncovered benefit
Guarantor
Electronic funds transfer ACT
50. 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.
Unassigned claim
Noncovered benefit
Chargemaster
Provider Remittance Notice