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. Abstract of all recent claims filed on each patient.






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






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






4. 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






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






6. 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.






7. Theperson eligible to receive healthcare benefits.






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






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






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






11. Contract out






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






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






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






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






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






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






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






19. The provider receives reimbursement directly from the payer.






20. 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;






21. 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






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






23. 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.






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






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






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






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






28. 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






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






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






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






32. 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






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






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






35. 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.






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






37. Medical report substantiating a medical condition






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






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






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






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






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






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






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






45. Computer to computer data exchange between payer and provider






46. The insurance claim form used to report professional services






47. 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






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






49. A correctly completed standardized claim






50. Organization that accredits clearinghouses