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. Submitted to the payer - but processing is not complete






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






3. 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.






4. Medical report substantiating a medical condition






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






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






7. Form used to report institutional - facility services.






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






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






10. Contract out






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






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






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






14. Computer to computer data exchange between payer and provider






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






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






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






18. 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






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






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






21. 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;






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






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






24. 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.






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






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






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






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






29. 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.






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






31. The insurance claim form used to report professional services






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






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






34. 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.






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






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






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






38. 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






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






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






41. 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






42. 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;






43. Theperson eligible to receive healthcare benefits.






44. Person responsible for paying healthcare fees






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






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






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






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






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