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Test your basic knowledge |
Health Insurance
Start Test
Study First
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.
Fair debt collection practicies Act
Out-of-pocket payment
Source document
Past-due account
2. A computerized permanent record of all financial transactions between the patient and the practice;also called patient account record.
Patient ledger
Equal Credit Opportunity ACT
Patient account record
UB-04
3. A claim that is usually more than 120 days past due; some practices establish time frames that are less than 120 days.
ANSI ASC X12 standards
UB-04
Deliquent claim
Allowed charges
4. Assigning lower-level codes then documented in the record.
Downcoding
Claims adjudication
Delinquent account
Participating provider
5. Claims for which all processing - including appeals - has been completed.
Fair credit reporting Act
Closed claim
Covered entity
Claims adjudication
6. The provider receives reimbursement directly from the payer.
Litigation
Assignment of benefits
Clearinghouse
Day sheet
7. The maximum amount a payer will reimburse for each procedure or service - according to the patient's policy.
Clean claim
Participating provider
Allowed charges
Value-added network (VAN)
8. 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.
Beneficiary
Noncovered benefit
Provider Remittance Notice
Fair credit reporting Act
9. Term used for the encounter form in the physicians's office.
Claims attachment
Superbill
Fair credit reporting Act
Provider Remittance Notice
10. 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
Out-of-pocket payment
Encounter form
Electronic flat file format
Accounts receivable aging report
11. 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
Delinquent account
Claims attachment
Fair credit reporting Act
Assignment of benefits
12. Establishes the rights. liabilites - and rsponsibilities of participants in electronic funds transfer systems.
Birthday rule
Electronic funds transfer ACT
Accounts receivable
Primary insurance
13. A computerized permanent record of all financial transactions between the patient and the pratice - also called patient ledger.
Electronic funds transfer ACT
Patient account record
Value-added network (VAN)
Provider Remittance Notice
14. Specifies what a collection source may or may not do when pursuing payment on past due accounts.
Accounts receivable aging report
Closed claim
Fair debt collection practicies Act
Noncovered benefit
15. Also called a day sheet - a chronological summary of all transactions posted to individual patient ledgers/accounts on a specific day.
Manual daily accounts receivable journal
Electronic funds transfer ACT
Fair debt collection practicies Act
Accounts receivable aging report
16. Contracts with a helath insurance plan and accepts whatever the plan pays for procedures or services performed.
Claims submission
Provider Remittance Notice
Coinsurance
Participating provider
17. Any medical condition that was diagnosed and or treated within a specified period of time immediately preceding the enrollee's effective date of coverage.
Electronic claim processing
Day sheet
Beneficiary
Pre-existing condition
18. Is a public or private entity that processes of facilitates the processing of nonstandard data elements into standard data elements.
Covered entity
Clearinghouse
Delinquent claim cycle
Common data file
19. The percentage the patient pays for covered services after the deductible has been met and the copayment has been paid.
Coinsurance
Guarantor
Electronic flat file format
ANSI ASC X12 standards
20. Contract out
Outsourcing
Chargemaster
Unassigned claim
Participating provider
21. Submitting multiple CPT codes when one code could of been submitted.
CMS-1500
Electronic funds transfer
Unbundling
Unauthorized service
22. Health plans - healthcare clearinghouses - government health plans - and any health providers that choose to submit or receive transactions electronically.
Clearinghouse
Consumer Credit Protection Act of 1968
Covered entity
Out-of-pocket payment
23. Sending data in a standardized machine readable format to an insurance company via disk - telephone or cable.
Electronic media claim
Electronic claim processing
Electronic data interchange EDI
Allowed charges
24. Accounts receivable that cannot be collected by the provider or a collect agency.
Participating provider
Bad debt
CMS-1500
Fair Credit and Charge Card Disclosure ACT
25. One that has not been paid within a certain time frame; also called delinquent account
Closed claim
Fair Credit and Charge Card Disclosure ACT
Electronic funds transfer ACT
Past-due account
26. Advances through various aging periods( 30 -60 -90 -120) with practices typically focusing internal recovery efforts on older delinquent accounts.
Accounts receivable aging report
Accounts receivable
Delinquent claim cycle
Allowed charges
27. Legal action to recover a debt; usually a last resort for a medical practice.
Litigation
Beneficiary
Patient ledger
Electronic claim processing
28. Organization that accredits clearinghouses
UB-04
Coinsurance
Electronic Healthcare Network Accreditation Commission EHNAC
ANSI ASC X12 standards
29. 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
Litigation
Electronic media claim
Consumer Credit Protection Act of 1968
Guarantor
30. Sorting claims upon submission to collect and verify information about a patient and provider.
Electronic remittance advi
Claims processing
Value-added network (VAN)
Participating provider
31. Abstract of all recent claims filed on each patient.
Participating provider
Common data file
Electronic funds transfer ACT
Delinquent claim cycle
32. Submitted to the payer - but processing is not complete
Equal Credit Opportunity ACT
Open claim
Chargemaster
Delinquent claim cycle
33. 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
Claims submission
Accept assignment
Allowed charges
Claims adjudication
34. Amount for which the patient is financially responsible before an insurance company provides coverage.
Deductible
Consumer Credit Protection Act of 1968
Unassigned claim
Source document
35. 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;
Nonparticipating provider
Fair Credit and Charge Card Disclosure ACT
ANSI ASC X12 standards
Open claim
36. Determines coverage by primary and secondary policies when each parent subscribes to a different health insurance plan.
ANSI ASC X12 standards
Deliquent claim
Manual daily accounts receivable journal
Birthday rule
37. Associated with how an insurance plan is billed-the insurance plan responsible for paying healthcare insurance claims first is considered primary.
ANSI ASC X12 standards
Out-of-pocket payment
Downcoding
Primary insurance
38. 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;
Fair Credit Billing Act
Source document
Deductible
Past-due account
39. Medical report substantiating a medical condition
Birthday rule
Coordination of benefits (COB)
Participating provider
Claims attachment
40. 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.
Guarantor
Accounts receivable management
Unassigned claim
Coordination of benefits (COB)
41. Services that are provided to a patient without proper authorization or that are not covered by a current authorization.
Deliquent claim
Superbill
Unauthorized service
Accept assignment
42. The term hospitals use to describe the encounter form.
Chargemaster
Delinquent claim cycle
Accounts receivable
Deductible
43. Uses a variable-length file format to process transactions for institutional - professional - dental - and drug claims.
Participating provider
Fair debt collection practicies Act
Accounts receivable management
ANSI ASC X12 standards
44. Person responsible for paying healthcare fees
Birthday rule
Guarantor
Delinquent account
Beneficiary
45. The transmission of claims data (electronical or manually) to payers or clearinghouses for processing.
Consumer Credit Protection Act of 1968
Fair credit reporting Act
Accounts receivable management
Claims submission
46. Series of fixed length records submitted to payers to bill for health care services.
Unbundling
Chargemaster
Electronic media claim
Guarantor
47. The insurance claim form used to report professional services
Pre-existing condition
Accounts receivable aging report
CMS-1500
Accept assignment
48. Financial record source document used by providers and other personnel to record treated diagnoses and services rendered to the patient during the current encounter.
Patient ledger
Unauthorized service
Accept assignment
Encounter form
49. Assists providers in the collection of appropriate reimbursement for services rendered; includes functions such as insurance verfication/eligibility and preauthorization of services
Delinquent account
Accounts receivable management
Fair debt collection practicies Act
Nonparticipating provider
50. 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.
Equal Credit Opportunity ACT
Consumer Credit Protection Act of 1968
UB-04
Fair Credit Billing Act