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. Person responsible for paying healthcare fees






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






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






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






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






6. Theperson eligible to receive healthcare benefits.






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






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






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






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






11. 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.






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






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






14. Contract out






15. 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






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






17. 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






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






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






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






21. The insurance claim form used to report professional services






22. Organization that accredits clearinghouses






23. 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.






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






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






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






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






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






29. A correctly completed standardized claim






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






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






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






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






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






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






37. 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.






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






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






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






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






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






43. Form used to report institutional - facility services.






44. 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;






45. 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;






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






47. 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






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






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






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