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






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






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






4. Person responsible for paying healthcare fees






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






6. Contract out






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






8. 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.






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






10. The insurance claim form used to report professional services






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






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






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






14. 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






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






16. 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.






17. Medical report substantiating a medical condition






18. 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;






19. The provider receives reimbursement directly from the payer.






20. 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.






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






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






23. 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






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






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






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






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






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






29. 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;






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






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






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






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






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






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






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






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






38. 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






39. Computer to computer data exchange between payer and provider






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






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






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






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






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






45. Theperson eligible to receive healthcare benefits.






46. Form used to report institutional - facility services.






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






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






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






50. 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.