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Health Insurance

Subject : industries
  • Answer 50 questions in 15 minutes.
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  • Match each statement with the correct term.
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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. Organization that accredits clearinghouses

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

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

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

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

6. Form used to report institutional - facility services.

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

8. 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

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

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

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

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

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

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

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

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

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

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

19. 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.

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

21. Determines coverage by primary and secondary policies when each parent subscribes to a different health insurance plan.

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

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

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

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

26. Person responsible for paying healthcare fees

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

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

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

30. 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.

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

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

34. System by which payers deposit funds to the providers account electronically.

35. 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

36. A correctly completed standardized claim

37. 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;

38. The provider receives reimbursement directly from the payer.

39. 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;

40. 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

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

42. 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.

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

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

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

46. Contract out

47. The insurance claim form used to report professional services

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

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

50. Computer to computer data exchange between payer and provider