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






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






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






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






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






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






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






8. The provider receives reimbursement directly from the payer.






9. 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






10. 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






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






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






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






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






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






16. 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






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






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






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






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






21. 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.






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






23. Form used to report institutional - facility services.






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






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






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






27. 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;






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






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






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






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






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






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






34. 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.






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






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






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






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






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






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






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






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






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






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






45. Theperson eligible to receive healthcare benefits.






46. Contract out






47. 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.






48. Organization that accredits clearinghouses






49. 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






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