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. Computer to computer data exchange between payer and provider






2. The provider receives reimbursement directly from the payer.






3. 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.






4. 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






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






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






7. Person responsible for paying healthcare fees






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






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






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






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






12. A correctly completed standardized claim






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






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. 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;






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






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






18. 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






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






20. Organization that accredits clearinghouses






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






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






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






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






25. 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.






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






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






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






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






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






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






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






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






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






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






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






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






38. 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.






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






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






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






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






43. Medical report substantiating a medical condition






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






45. The insurance claim form used to report professional services






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






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






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






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






50. Theperson eligible to receive healthcare benefits.






Can you answer 50 questions in 15 minutes?



Let me suggest you:

Browse all subjects

Browse all tests

Most popular tests



Major Subjects

Tests & Exams


AP
CLEP
DSST
GRE
SAT
GMAT

Browse all subjects

Browse all tests

Most popular tests