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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. 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
Electronic funds transfer
Participating provider
Guarantor
Value-added network (VAN)
2. Series of fixed length records submitted to payers to bill for health care services.
Birthday rule
Provider Remittance Notice
Electronic flat file format
ANSI ASC X12 standards
3. 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;
Allowed charges
Fair Credit and Charge Card Disclosure ACT
Consumer Credit Protection Act of 1968
Fair Credit Billing Act
4. Series of fixed length records submitted to payers to bill for health care services.
Open claim
Electronic media claim
Participating provider
Claims submission
5. Assists providers in the collection of appropriate reimbursement for services rendered; includes functions such as insurance verfication/eligibility and preauthorization of services
Value-added network (VAN)
Accounts receivable management
Consumer Credit Protection Act of 1968
Primary insurance
6. Services that are provided to a patient without proper authorization or that are not covered by a current authorization.
Claims submission
Source document
Unauthorized service
Clean claim
7. A correctly completed standardized claim
Fair credit reporting Act
Electronic funds transfer ACT
Clean claim
Chargemaster
8. Health plans - healthcare clearinghouses - government health plans - and any health providers that choose to submit or receive transactions electronically.
Consumer Credit Protection Act of 1968
Covered entity
ANSI ASC X12 standards
Delinquent claim cycle
9. Does not contract with the insurance plan; patient who elects to recieve care from nonPARS will incur higher out-of-pocket expenses.
Nonparticipating provider
Delinquent claim cycle
Claims processing
Manual daily accounts receivable journal
10. The maximum amount a payer will reimburse for each procedure or service - according to the patient's policy.
Electronic claim processing
Chargemaster
Allowed charges
Fair Credit and Charge Card Disclosure ACT
11. Form used to report institutional - facility services.
Equal Credit Opportunity ACT
Pre-existing condition
Unassigned claim
UB-04
12. 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
Accounts receivable management
Beneficiary
13. Financial record source document used by providers and other personnel to record treated diagnoses and services rendered to the patient during the current encounter.
Encounter form
Nonparticipating provider
Claims submission
Fair debt collection practicies Act
14. Legal action to recover a debt; usually a last resort for a medical practice.
Litigation
Accept assignment
Electronic flat file format
Common data file
15. 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.
Unassigned claim
Past-due account
Bad debt
UB-04
16. The percentage the patient pays for covered services after the deductible has been met and the copayment has been paid.
Coinsurance
Downcoding
Pre-existing condition
Electronic funds transfer ACT
17. A claim that is usually more than 120 days past due; some practices establish time frames that are less than 120 days.
Electronic funds transfer
Covered entity
Deliquent claim
Electronic media claim
18. Contracts with a helath insurance plan and accepts whatever the plan pays for procedures or services performed.
Accept assignment
Participating provider
ANSI ASC X12 standards
UB-04
19. The transmission of claims data (electronical or manually) to payers or clearinghouses for processing.
Claims submission
Fair Credit and Charge Card Disclosure ACT
Delinquent account
Day sheet
20. Is a past due account; one that has not been paid within a certain time frame.
Chargemaster
Patient account record
Delinquent account
Unbundling
21. 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
Assignment of benefits
Out-of-pocket payment
Unauthorized service
Electronic flat file format
22. Advances through various aging periods( 30 -60 -90 -120) with practices typically focusing internal recovery efforts on older delinquent accounts.
Birthday rule
Claims submission
Two-party check
Delinquent claim cycle
23. 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
Two-party check
Open claim
Common data file
24. A check made out to the patient and the provider.
Two-party check
Unassigned claim
Claims adjudication
Electronic Healthcare Network Accreditation Commission EHNAC
25. Determines coverage by primary and secondary policies when each parent subscribes to a different health insurance plan.
Birthday rule
Fair credit reporting Act
Delinquent account
Outsourcing
26. 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
Fair Credit Billing Act
Encounter form
CMS-1500
Claims adjudication
27. The insurance claim form used to report professional services
Bad debt
Fair Credit and Charge Card Disclosure ACT
CMS-1500
Coinsurance
28. One that has not been paid within a certain time frame; also called delinquent account
Delinquent claim cycle
Past-due account
Provider Remittance Notice
Superbill
29. System by which payers deposit funds to the providers account electronically.
Assignment of benefits
Electronic Healthcare Network Accreditation Commission EHNAC
Electronic funds transfer
Covered entity
30. The provider receives reimbursement directly from the payer.
Assignment of benefits
Two-party check
Fair credit reporting Act
Covered entity
31. Term used for the encounter form in the physicians's office.
Allowed charges
Claims attachment
Value-added network (VAN)
Superbill
32. Also called a day sheet - a chronological summary of all transactions posted to individual patient ledgers/accounts on a specific day.
Manual daily accounts receivable journal
Electronic claim processing
Clean claim
Claims attachment
33. Person responsible for paying healthcare fees
Fair Credit and Charge Card Disclosure ACT
Encounter form
Guarantor
Fair debt collection practicies Act
34. 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
Consumer Credit Protection Act of 1968
Litigation
Deliquent claim
35. Associated with how an insurance plan is billed-the insurance plan responsible for paying healthcare insurance claims first is considered primary.
Primary insurance
Chargemaster
Assignment of benefits
Allowed charges
36. Establishes the rights. liabilites - and rsponsibilities of participants in electronic funds transfer systems.
Manual daily accounts receivable journal
Claims attachment
Day sheet
Electronic funds transfer ACT
37. Organization that accredits clearinghouses
Allowed charges
Accounts receivable
Electronic media claim
Electronic Healthcare Network Accreditation Commission EHNAC
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.
Superbill
Source document
Coordination of benefits (COB)
Provider Remittance Notice
39. Submitted to the payer - but processing is not complete
Open claim
Common data file
Closed claim
Clean claim
40. Shows the status (by date) of outstanding claims from each payer - as well as payments due from patients
Allowed charges
Consumer Credit Protection Act of 1968
Bad debt
Accounts receivable aging report
41. The amount owed to a business for services or goods provided
Delinquent claim cycle
Fair debt collection practicies Act
UB-04
Accounts receivable
42. Sending data in a standardized machine readable format to an insurance company via disk - telephone or cable.
Electronic remittance advi
Electronic claim processing
Electronic data interchange EDI
Fair credit reporting Act
43. Medical report substantiating a medical condition
Fair debt collection practicies Act
Electronic data interchange EDI
Noncovered benefit
Claims attachment
44. Contract out
Primary insurance
Outsourcing
Open claim
Fair Credit and Charge Card Disclosure ACT
45. When the provider agrees to accept what the insurance company allows or aproves as payment in full for the claim
Accept assignment
Unassigned claim
Electronic claim processing
Electronic funds transfer ACT
46. A computerized permanent record of all financial transactions between the patient and the practice;also called patient account record.
Coordination of benefits (COB)
Accounts receivable aging report
Patient ledger
Pre-existing condition
47. Computer to computer data exchange between payer and provider
Deductible
Electronic data interchange EDI
Unbundling
Accounts receivable aging report
48. The term hospitals use to describe the encounter form.
Chargemaster
Equal Credit Opportunity ACT
Manual daily accounts receivable journal
Fair Credit and Charge Card Disclosure ACT
49. Amount for which the patient is financially responsible before an insurance company provides coverage.
Delinquent claim cycle
Deductible
Value-added network (VAN)
Accounts receivable
50. 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.
Beneficiary
Source document
Open claim
Electronic remittance advi