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. The provider receives reimbursement directly from the payer.






2. Theperson eligible to receive healthcare benefits.






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






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






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






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






7. 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.






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






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






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






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






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






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






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






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






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






17. 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;






18. The insurance claim form used to report professional services






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






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






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






22. 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.






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






24. Medical report substantiating a medical condition






25. Person responsible for paying healthcare fees






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






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






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






29. 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






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






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






32. 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






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






34. Contract out






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






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






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






38. Organization that accredits clearinghouses






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






40. 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






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






42. 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






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






44. 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.






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. 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.






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






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. Computer to computer data exchange between payer and provider






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







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