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






2. The provider receives reimbursement directly from the payer.






3. A correctly completed standardized claim






4. 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;






5. 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






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






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






8. 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






9. 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;






10. Form used to report institutional - facility services.






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






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






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






14. 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.






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






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






17. 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.






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






19. 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






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






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






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






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






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






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






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






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






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






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






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






31. Contract out






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






33. Theperson eligible to receive healthcare benefits.






34. 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






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






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






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






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






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






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






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






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






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






44. Medical report substantiating a medical condition






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






46. 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.






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






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






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






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