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






3. Person responsible for paying healthcare fees






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






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






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






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






8. 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.






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






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






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






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






13. A correctly completed standardized claim






14. 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






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






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






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






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






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






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






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






22. The term hospitals use to describe the encounter form.






23. Organization that accredits clearinghouses






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






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






26. 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.






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






28. 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






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






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






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






32. Contract out






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






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






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






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






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






38. 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.






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






40. Theperson eligible to receive healthcare benefits.






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






42. Computer to computer data exchange between payer and provider






43. 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






44. 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






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






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






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






48. 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.






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






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