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






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






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






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






5. A correctly completed standardized claim






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






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






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






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






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






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






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






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






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






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






16. 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.






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






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






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






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






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






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






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






24. Medical report substantiating a medical condition






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






26. Form used to report institutional - facility services.






27. 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.






28. Organization that accredits clearinghouses






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






30. 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






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. The insurance claim form used to report professional services






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






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






35. 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






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






37. Person responsible for paying healthcare fees






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






39. Computer to computer data exchange between payer and provider






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






41. The provider receives reimbursement directly from the payer.






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






43. 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






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






45. 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.






46. Theperson eligible to receive healthcare benefits.






47. 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.






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






49. 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;






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