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Health Insurance

Subject : industries
Instructions:
  • Answer 50 questions in 15 minutes.
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  • 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 provider receives reimbursement directly from the payer.






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






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






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






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






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






7. Form used to report institutional - facility services.






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






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






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






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






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






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






14. 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.






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






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






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






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






19. A correctly completed standardized claim






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






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






22. The insurance claim form used to report professional services






23. 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.






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






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






26. Organization that accredits clearinghouses






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






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






29. 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.






30. 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






31. Medical report substantiating a medical condition






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






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






34. 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






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






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






37. Contract out






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






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






41. Computer to computer data exchange between payer and provider






42. Person responsible for paying healthcare fees






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






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






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






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






47. 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






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






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






50. 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







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