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






2. Person responsible for paying healthcare fees






3. Organization that accredits clearinghouses






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






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






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






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






8. 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






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






10. 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.






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






12. The provider receives reimbursement directly from the payer.






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






14. 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;






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






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






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






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






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






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






21. Medical report substantiating a medical condition






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






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






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






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






26. 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.






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






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






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






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






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






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






34. Theperson eligible to receive healthcare benefits.






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






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






37. The insurance claim form used to report professional services






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






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






40. 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.






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






42. 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






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






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






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






46. A correctly completed standardized claim






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






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






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