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






2. 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;






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






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






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






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






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






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






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






11. 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






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






13. 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.






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






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






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






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






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






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






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






21. 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






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






23. A correctly completed standardized claim






24. The provider receives reimbursement directly from the payer.






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






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






27. Contract out






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






29. 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.






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






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






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






33. 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;






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






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






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






37. Theperson eligible to receive healthcare benefits.






38. 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.






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






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






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






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






43. Medical report substantiating a medical condition






44. 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.






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






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






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






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






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






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