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. 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.






2. 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;






3. 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.






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






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






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






7. 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






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






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






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






11. 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;






12. The provider receives reimbursement directly from the payer.






13. 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.






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






15. Contract out






16. 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.






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






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






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






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






21. The insurance claim form used to report professional services






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






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






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






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






26. 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.






27. 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






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






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






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






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






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






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






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






35. Medical report substantiating a medical condition






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






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






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






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






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






41. Form used to report institutional - facility services.






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






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






44. Person responsible for paying healthcare fees






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






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






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






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






49. A correctly completed standardized claim






50. Theperson eligible to receive healthcare benefits.