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






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






3. 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






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






5. Person responsible for paying healthcare fees






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






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






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






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






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






11. 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.






12. The insurance claim form used to report professional services






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






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






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






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






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






18. A correctly completed standardized claim






19. 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;






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






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






22. 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.






23. Computer to computer data exchange between payer and provider






24. 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






25. The provider receives reimbursement directly from the payer.






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






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






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






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






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






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






32. 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






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






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






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






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






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. Organization that accredits clearinghouses






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






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






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. Contract out






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






45. 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.






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






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






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






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






50. 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;