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. Theperson eligible to receive healthcare benefits.






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






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






4. 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






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






6. 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.






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






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






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






10. 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






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






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






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






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






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






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






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






18. Contract out






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






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






21. The provider receives reimbursement directly from the payer.






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






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






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






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






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






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






28. 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






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






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






31. 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;






32. Organization that accredits clearinghouses






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






35. A correctly completed standardized claim






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






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






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






39. Computer to computer data exchange between payer and provider






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






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






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






43. Person responsible for paying healthcare fees






44. Form used to report institutional - facility services.






45. 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.






46. 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;






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






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






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






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