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