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






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






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






4. 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.






5. Theperson eligible to receive healthcare benefits.






6. Form used to report institutional - facility services.






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






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






9. Medical report substantiating a medical condition






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






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






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






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






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






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






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






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






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






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






20. Contract out






21. Organization that accredits clearinghouses






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






23. The provider receives reimbursement directly from the payer.






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






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






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






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






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






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






31. 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






32. A correctly completed standardized claim






33. 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






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






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






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






37. 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






38. 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;






39. 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






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






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






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






43. 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.






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






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






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






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






48. 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






49. 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.






50. 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.