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






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






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






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






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






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






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






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






9. A correctly completed standardized claim






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






11. Computer to computer data exchange between payer and provider






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






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






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






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






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






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






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






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






20. Form used to report institutional - facility services.






21. The insurance claim form used to report professional services






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






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






24. Medical report substantiating a medical condition






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






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






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






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






29. 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.






30. Theperson eligible to receive healthcare benefits.






31. 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.






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






33. 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






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






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






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






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






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.






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






40. Organization that accredits clearinghouses






41. 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;






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






43. Person responsible for paying healthcare fees






44. 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;






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






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






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






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






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






50. 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