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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. Assists providers in the collection of appropriate reimbursement for services rendered; includes functions such as insurance verfication/eligibility and preauthorization of services
Fair Credit and Charge Card Disclosure ACT
Litigation
Accounts receivable management
Bad debt
2. Is a past due account; one that has not been paid within a certain time frame.
Noncovered benefit
Consumer Credit Protection Act of 1968
Delinquent account
Fair Credit Billing Act
3. Submitting multiple CPT codes when one code could of been submitted.
Electronic claim processing
Nonparticipating provider
Unbundling
Allowed charges
4. System by which payers deposit funds to the providers account electronically.
Electronic remittance advi
Fair credit reporting Act
Electronic data interchange EDI
Electronic funds transfer
5. The transmission of claims data (electronical or manually) to payers or clearinghouses for processing.
Claims adjudication
Allowed charges
Value-added network (VAN)
Claims submission
6. 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
Beneficiary
Closed claim
Out-of-pocket payment
Open claim
7. One that has not been paid within a certain time frame; also called delinquent account
Beneficiary
Patient ledger
Past-due account
Source document
8. 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
Electronic media claim
Out-of-pocket payment
Fair credit reporting Act
Encounter form
9. A computerized permanent record of all financial transactions between the patient and the practice;also called patient account record.
Patient ledger
Deliquent claim
Beneficiary
Assignment of benefits
10. 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.
Provider Remittance Notice
Equal Credit Opportunity ACT
Manual daily accounts receivable journal
Noncovered benefit
11. Contract out
Outsourcing
Accounts receivable
Litigation
Delinquent account
12. Establishes the rights. liabilites - and rsponsibilities of participants in electronic funds transfer systems.
Closed claim
Encounter form
Chargemaster
Electronic funds transfer ACT
13. When the provider agrees to accept what the insurance company allows or aproves as payment in full for the claim
Participating provider
Guarantor
Consumer Credit Protection Act of 1968
Accept assignment
14. 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.
Coordination of benefits (COB)
Consumer Credit Protection Act of 1968
Beneficiary
Fair Credit and Charge Card Disclosure ACT
15. 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.
Guarantor
Outsourcing
Litigation
Noncovered benefit
16. Associated with how an insurance plan is billed-the insurance plan responsible for paying healthcare insurance claims first is considered primary.
Patient account record
Primary insurance
Day sheet
Accounts receivable management
17. Computer to computer data exchange between payer and provider
Accounts receivable management
Unassigned claim
Source document
Electronic data interchange EDI
18. Determines coverage by primary and secondary policies when each parent subscribes to a different health insurance plan.
Birthday rule
Patient account record
Electronic funds transfer
Accounts receivable management
19. A claim that is usually more than 120 days past due; some practices establish time frames that are less than 120 days.
Fair debt collection practicies Act
Deliquent claim
Downcoding
Coordination of benefits (COB)
20. Advances through various aging periods( 30 -60 -90 -120) with practices typically focusing internal recovery efforts on older delinquent accounts.
Delinquent claim cycle
Coinsurance
Deductible
Allowed charges
21. Amount for which the patient is financially responsible before an insurance company provides coverage.
Delinquent claim cycle
Coinsurance
Past-due account
Deductible
22. Sending data in a standardized machine readable format to an insurance company via disk - telephone or cable.
Electronic claim processing
Day sheet
Fair Credit Billing Act
Clearinghouse
23. 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.
Encounter form
Electronic remittance advi
Day sheet
Patient ledger
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;
Nonparticipating provider
Accounts receivable
Fair Credit and Charge Card Disclosure ACT
Patient account record
25. Series of fixed length records submitted to payers to bill for health care services.
Claims adjudication
Clearinghouse
Electronic flat file format
Claims submission
26. 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
Allowed charges
CMS-1500
Fair Credit Billing Act
27. Health plans - healthcare clearinghouses - government health plans - and any health providers that choose to submit or receive transactions electronically.
Primary insurance
Patient ledger
Nonparticipating provider
Covered entity
28. The percentage the patient pays for covered services after the deductible has been met and the copayment has been paid.
Coinsurance
CMS-1500
Clean claim
Participating provider
29. Series of fixed length records submitted to payers to bill for health care services.
Fair Credit Billing Act
Fair debt collection practicies Act
Clean claim
Electronic media claim
30. Term used for the encounter form in the physicians's office.
Superbill
Day sheet
Value-added network (VAN)
Source document
31. A check made out to the patient and the provider.
Common data file
Delinquent account
Two-party check
Fair debt collection practicies Act
32. Financial record source document used by providers and other personnel to record treated diagnoses and services rendered to the patient during the current encounter.
Guarantor
Encounter form
Nonparticipating provider
Patient account record
33. Remittance advice submitted by Medicare to providers that includes payment information about a claim.
Accept assignment
Provider Remittance Notice
Fair Credit and Charge Card Disclosure ACT
Two-party check
34. The maximum amount a payer will reimburse for each procedure or service - according to the patient's policy.
Deliquent claim
Birthday rule
Encounter form
Allowed charges
35. 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
Out-of-pocket payment
Value-added network (VAN)
Electronic funds transfer
Claims submission
36. Contracts with a helath insurance plan and accepts whatever the plan pays for procedures or services performed.
Out-of-pocket payment
Birthday rule
Manual daily accounts receivable journal
Participating provider
37. Also called manual daily accounts receivable journal; cronological summary of all transactions posted to individual patient legers/accounts on a specific day.
Common data file
Accounts receivable management
Fair Credit Billing Act
Day sheet
38. Is a public or private entity that processes of facilitates the processing of nonstandard data elements into standard data elements.
Electronic funds transfer ACT
Encounter form
Nonparticipating provider
Clearinghouse
39. Form used to report institutional - facility services.
Closed claim
Two-party check
UB-04
Primary insurance
40. A routing slip - charge slip - encounter form - or suberbill from which the insurance claim was generated.
Source document
Fair Credit and Charge Card Disclosure ACT
UB-04
Claims submission
41. Organization that accredits clearinghouses
Patient ledger
Litigation
Electronic Healthcare Network Accreditation Commission EHNAC
Fair Credit Billing Act
42. Shows the status (by date) of outstanding claims from each payer - as well as payments due from patients
Accounts receivable aging report
Allowed charges
Birthday rule
Patient account record
43. The insurance claim form used to report professional services
Electronic Healthcare Network Accreditation Commission EHNAC
Noncovered benefit
CMS-1500
Outsourcing
44. Abstract of all recent claims filed on each patient.
Common data file
Covered entity
CMS-1500
ANSI ASC X12 standards
45. Assigning lower-level codes then documented in the record.
Unauthorized service
Delinquent claim cycle
Patient account record
Downcoding
46. Submitted to the payer - but processing is not complete
Fair credit reporting Act
Open claim
Unassigned claim
Fair debt collection practicies Act
47. Sorting claims upon submission to collect and verify information about a patient and provider.
Claims processing
Past-due account
Allowed charges
Day sheet
48. 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
Fair credit reporting Act
Past-due account
Electronic Healthcare Network Accreditation Commission EHNAC
49. Claims for which all processing - including appeals - has been completed.
Closed claim
Open claim
Nonparticipating provider
Noncovered benefit
50. Specifies what a collection source may or may not do when pursuing payment on past due accounts.
Past-due account
Unauthorized service
Fair debt collection practicies Act
Beneficiary