Test your basic knowledge |

Health Insurance

Subject : industries
  • 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. 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.

2. The provider receives reimbursement directly from the payer.

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

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

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

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

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

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

9. The insurance claim form used to report professional services

10. Form used to report institutional - facility services.

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

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

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

14. 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.

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

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

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

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

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

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

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

22. Computer to computer data exchange between payer and provider

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

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

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

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

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

28. 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

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

30. A correctly completed standardized claim

31. 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;

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

33. 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

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

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

36. Organization that accredits clearinghouses

37. 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;

38. 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

39. Medical report substantiating a medical condition

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

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

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

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

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

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

46. Theperson eligible to receive healthcare benefits.

47. 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

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

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

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