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Health Insurance

Subject : industries
  • Answer 50 questions in 15 minutes.
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  • 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. Shows the status (by date) of outstanding claims from each payer - as well as payments due from patients

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

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

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

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

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

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

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

10. 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.

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

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

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

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

15. Contract out

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

17. 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.

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

19. The provider receives reimbursement directly from the payer.

20. Person responsible for paying healthcare fees

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

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

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

24. A correctly completed standardized claim

25. 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.

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

27. 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

28. 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

29. Organization that accredits clearinghouses

30. 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

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

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

33. Established by health insurance companies for a health insurance plan; usually has limits of $1000 or $2000; when the patient has reached the limit of an out-of-pocket payment (deductable) for the year - appropriate patient reimbursement to the provi

34. Medical report substantiating a medical condition

35. Form used to report institutional - facility services.

36. 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;

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

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

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

40. 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.

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

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

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

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

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

46. The insurance claim form used to report professional services

47. Computer to computer data exchange between payer and provider

48. 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;

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

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