SUBJECTS
|
BROWSE
|
CAREER CENTER
|
POPULAR
|
JOIN
|
LOGIN
Business Skills
|
Soft Skills
|
Basic Literacy
|
Certifications
About
|
Help
|
Privacy
|
Terms
|
Email
Search
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. Is a public or private entity that processes of facilitates the processing of nonstandard data elements into standard data elements.
Electronic claim processing
Claims submission
CMS-1500
Clearinghouse
2. The provider receives reimbursement directly from the payer.
Electronic remittance advi
Assignment of benefits
Unassigned claim
Coinsurance
3. A correctly completed standardized claim
Birthday rule
Clean claim
Deductible
Litigation
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;
Fair Credit and Charge Card Disclosure ACT
Coordination of benefits (COB)
Claims processing
Patient account record
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
ANSI ASC X12 standards
CMS-1500
Claims adjudication
Claims submission
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.
Pre-existing condition
Electronic funds transfer ACT
Fair debt collection practicies Act
Delinquent account
7. Uses a variable-length file format to process transactions for institutional - professional - dental - and drug claims.
Downcoding
Claims processing
Birthday rule
ANSI ASC X12 standards
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
Covered entity
Value-added network (VAN)
Unauthorized service
Downcoding
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;
Accounts receivable management
Pre-existing condition
Fair Credit Billing Act
Downcoding
10. Form used to report institutional - facility services.
Deliquent claim
ANSI ASC X12 standards
UB-04
Source document
11. Remittance advice submitted by Medicare to providers that includes payment information about a claim.
Provider Remittance Notice
Pre-existing condition
Allowed charges
Electronic remittance advi
12. One that has not been paid within a certain time frame; also called delinquent account
Open claim
Clean claim
CMS-1500
Past-due account
13. Abstract of all recent claims filed on each patient.
Past-due account
Value-added network (VAN)
Pre-existing condition
Common data file
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.
Value-added network (VAN)
Accounts receivable management
Electronic remittance advi
Out-of-pocket payment
15. A check made out to the patient and the provider.
Covered entity
Manual daily accounts receivable journal
Two-party check
Primary insurance
16. The maximum amount a payer will reimburse for each procedure or service - according to the patient's policy.
UB-04
Two-party check
Noncovered benefit
Allowed charges
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.
Encounter form
Coordination of benefits (COB)
Day sheet
Litigation
18. Services that are provided to a patient without proper authorization or that are not covered by a current authorization.
Birthday rule
Past-due account
Clean claim
Unauthorized service
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
Deductible
Out-of-pocket payment
Deliquent claim
Guarantor
20. Submitted to the payer - but processing is not complete
Pre-existing condition
Beneficiary
Open claim
Delinquent account
21. A computerized permanent record of all financial transactions between the patient and the practice;also called patient account record.
Nonparticipating provider
Allowed charges
Patient ledger
Consumer Credit Protection Act of 1968
22. Sorting claims upon submission to collect and verify information about a patient and provider.
Electronic funds transfer
Past-due account
UB-04
Claims processing
23. Advances through various aging periods( 30 -60 -90 -120) with practices typically focusing internal recovery efforts on older delinquent accounts.
Delinquent claim cycle
Electronic data interchange EDI
Downcoding
UB-04
24. Does not contract with the insurance plan; patient who elects to recieve care from nonPARS will incur higher out-of-pocket expenses.
Electronic flat file format
Accounts receivable management
Assignment of benefits
Nonparticipating provider
25. The transmission of claims data (electronical or manually) to payers or clearinghouses for processing.
Accounts receivable aging report
Unbundling
Claims submission
Open claim
26. Series of fixed length records submitted to payers to bill for health care services.
Outsourcing
Electronic remittance advi
Source document
Electronic media claim
27. Series of fixed length records submitted to payers to bill for health care services.
Fair credit reporting Act
Fair Credit Billing Act
Electronic flat file format
Delinquent claim cycle
28. A claim that is usually more than 120 days past due; some practices establish time frames that are less than 120 days.
Electronic flat file format
Deliquent claim
Manual daily accounts receivable journal
Two-party check
29. Legal action to recover a debt; usually a last resort for a medical practice.
Chargemaster
Unbundling
UB-04
Litigation
30. Determines coverage by primary and secondary policies when each parent subscribes to a different health insurance plan.
Covered entity
Birthday rule
Electronic funds transfer ACT
CMS-1500
31. Contract out
Outsourcing
CMS-1500
Fair Credit and Charge Card Disclosure ACT
Superbill
32. Health plans - healthcare clearinghouses - government health plans - and any health providers that choose to submit or receive transactions electronically.
Noncovered benefit
Allowed charges
Electronic media claim
Covered entity
33. Theperson eligible to receive healthcare benefits.
Beneficiary
Day sheet
Assignment of benefits
Out-of-pocket payment
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
Consumer Credit Protection Act of 1968
Electronic funds transfer ACT
Unbundling
Out-of-pocket payment
35. Assigning lower-level codes then documented in the record.
Fair credit reporting Act
Closed claim
Accounts receivable
Downcoding
36. Is a past due account; one that has not been paid within a certain time frame.
Clean claim
Closed claim
Delinquent account
Out-of-pocket payment
37. System by which payers deposit funds to the providers account electronically.
Past-due account
Closed claim
Source document
Electronic funds transfer
38. Also called a day sheet - a chronological summary of all transactions posted to individual patient ledgers/accounts on a specific day.
Value-added network (VAN)
Unauthorized service
Accounts receivable management
Manual daily accounts receivable journal
39. The amount owed to a business for services or goods provided
Guarantor
Deliquent claim
Accounts receivable
Manual daily accounts receivable journal
40. Specifies what a collection source may or may not do when pursuing payment on past due accounts.
Fair debt collection practicies Act
Deliquent claim
ANSI ASC X12 standards
Source document
41. Associated with how an insurance plan is billed-the insurance plan responsible for paying healthcare insurance claims first is considered primary.
Covered entity
Past-due account
Primary insurance
Patient account record
42. When the provider agrees to accept what the insurance company allows or aproves as payment in full for the claim
Accept assignment
Beneficiary
Patient account record
Electronic media claim
43. Shows the status (by date) of outstanding claims from each payer - as well as payments due from patients
Accounts receivable aging report
Assignment of benefits
Electronic funds transfer
Patient ledger
44. Medical report substantiating a medical condition
Claims attachment
Litigation
Electronic funds transfer
Unauthorized service
45. Accounts receivable that cannot be collected by the provider or a collect agency.
Downcoding
Bad debt
Open claim
Claims adjudication
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.
Chargemaster
Equal Credit Opportunity ACT
Electronic funds transfer ACT
Electronic remittance advi
47. Contracts with a helath insurance plan and accepts whatever the plan pays for procedures or services performed.
Accounts receivable
Participating provider
Equal Credit Opportunity ACT
Coinsurance
48. Establishes the rights. liabilites - and rsponsibilities of participants in electronic funds transfer systems.
Patient ledger
Clearinghouse
Electronic funds transfer ACT
Claims adjudication
49. Term used for the encounter form in the physicians's office.
Two-party check
Day sheet
Electronic Healthcare Network Accreditation Commission EHNAC
Superbill
50. A computerized permanent record of all financial transactions between the patient and the pratice - also called patient ledger.
Two-party check
Day sheet
Electronic funds transfer
Patient account record