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. Abstract of all recent claims filed on each patient.






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






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






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






5. Person responsible for paying healthcare fees






6. Organization that accredits clearinghouses






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






8. The insurance claim form used to report professional services






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






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






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






12. 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






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






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






16. 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.






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






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






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






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






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






22. 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.






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






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






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






26. 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;






27. A correctly completed standardized claim






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






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






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






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






32. 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.






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






34. Theperson eligible to receive healthcare benefits.






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






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






37. Computer to computer data exchange between payer and provider






38. The provider receives reimbursement directly from the payer.






39. Medical report substantiating a medical condition






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






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






42. 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.






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






44. 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






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






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






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






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






49. 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.






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