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






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






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






4. Uses a variable-length file format to process transactions for institutional - professional - dental - and drug claims.






5. A claim that is usually more than 120 days past due; some practices establish time frames that are less than 120 days.






6. 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.






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






8. Assists providers in the collection of appropriate reimbursement for services rendered; includes functions such as insurance verfication/eligibility and preauthorization of services






9. The provider receives reimbursement directly from the payer.






10. 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;






11. 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






12. The insurance claim form used to report professional services






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






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






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






16. Theperson eligible to receive healthcare benefits.






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






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






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






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






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






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






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






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






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






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






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






28. A correctly completed standardized claim






29. 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






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






31. Computer to computer data exchange between payer and provider






32. 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






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






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






35. 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.






36. 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.






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






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






39. Organization that accredits clearinghouses






40. 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.






41. Medical report substantiating a medical condition






42. 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






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






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






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






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






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






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






49. Contract out






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