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. The term hospitals use to describe the encounter form.






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






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






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






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






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






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






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






9. Person responsible for paying healthcare fees






10. Form used to report institutional - facility services.






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






12. 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






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






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






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






16. The insurance claim form used to report professional services






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






18. Contract out






19. 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






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






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






22. 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;






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






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






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






26. Medical report substantiating a medical condition






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






28. 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.






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






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






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






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






33. 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.






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






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






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






37. 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.






38. 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.






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






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






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






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






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






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






45. 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.






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






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






48. 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






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






50. Computer to computer data exchange between payer and provider