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






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






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






4. 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






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






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






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






8. Medical report substantiating a medical condition






9. 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.






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






11. 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.






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






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






14. Organization that accredits clearinghouses






15. A correctly completed standardized claim






16. The provider receives reimbursement directly from the payer.






17. Computer to computer data exchange between payer and provider






18. 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;






19. 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.






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






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






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






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






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






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






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






27. Theperson eligible to receive healthcare benefits.






28. 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.






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






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






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






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






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






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






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






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






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






39. Person responsible for paying healthcare fees






40. 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.






41. 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;






42. The insurance claim form used to report professional services






43. 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






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






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






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






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






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






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






50. Form used to report institutional - facility services.