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






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






4. 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.






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






6. 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.






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






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






9. Computer to computer data exchange between payer and provider






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






11. A correctly completed standardized claim






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






13. 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;






14. 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






15. 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.






16. 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






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






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






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






20. Theperson eligible to receive healthcare benefits.






21. The insurance claim form used to report professional services






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






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






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






25. Organization that accredits clearinghouses






26. 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;






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






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






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






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






31. Medical report substantiating a medical condition






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






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






35. Contract out






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






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






38. The provider receives reimbursement directly from the payer.






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






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






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






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






43. 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






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






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






46. Prohibits discrimination on the basis of race - color - religion - national origin - sex - martial status - age - reciept of public assistance - or good faith exercise of any rights under the Cunsumer Credit protection ACT.






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






48. 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.






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






50. Form used to report institutional - facility services.






Can you answer 50 questions in 15 minutes?



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