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. Theperson eligible to receive healthcare benefits.






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






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






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






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






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






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






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






9. Computer to computer data exchange between payer and provider






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






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






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






13. Medical report substantiating a medical condition






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






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






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






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






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






19. The provider receives reimbursement directly from the payer.






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






21. Form used to report institutional - facility services.






22. Organization that accredits clearinghouses






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






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






25. 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.






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






27. 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.






28. Contract out






29. 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






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






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






32. 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;






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






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






35. 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






36. 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






37. 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.






38. 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.






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






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






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






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






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






44. 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;






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






46. A correctly completed standardized claim






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






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.






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






50. 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.