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






2. 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






3. The provider receives reimbursement directly from the payer.






4. 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






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






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






7. Organization that accredits clearinghouses






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.






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






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






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






12. Person responsible for paying healthcare fees






13. 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.






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






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






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






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






18. Contract out






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






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






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






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






23. 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






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. 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;






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






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






28. Medical report substantiating a medical condition






29. 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;






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






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






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






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






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






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






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






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






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






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






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.






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






42. A correctly completed standardized claim






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






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






45. 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.






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






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






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






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






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







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