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. Medical report substantiating a medical condition






2. 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






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






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






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






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






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






8. Person responsible for paying healthcare fees






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






10. 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






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






12. 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;






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






14. 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.






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






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






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






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






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






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






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






22. A correctly completed standardized claim






23. Theperson eligible to receive healthcare benefits.






24. Computer to computer data exchange between payer and provider






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






26. Contract out






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






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






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






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






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






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






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






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






35. 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;






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






37. 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






38. 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.






39. Organization that accredits clearinghouses






40. 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






41. The insurance claim form used to report professional services






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






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






44. 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.






45. 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






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






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






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






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






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