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. 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






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






3. 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;






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






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






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






7. A correctly completed standardized claim






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






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






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






11. Form used to report institutional - facility services.






12. 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






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






15. 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.






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






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






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






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






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






21. 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






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






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






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






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






26. 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






27. The insurance claim form used to report professional services






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






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






30. The provider receives reimbursement directly from the payer.






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






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






33. Person responsible for paying healthcare fees






34. 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;






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






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






37. Organization that accredits clearinghouses






38. 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.






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






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






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






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






43. Medical report substantiating a medical condition






44. Contract out






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






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






47. Computer to computer data exchange between payer and provider






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






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






50. 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.