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Health Insurance

Subject : industries
Instructions:
  • Answer 50 questions in 15 minutes.
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  • 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 transmission of claims data (electronical or manually) to payers or clearinghouses for processing.






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






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






4. Person responsible for paying healthcare fees






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






6. Form used to report institutional - facility services.






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






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






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






10. The insurance claim form used to report professional services






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






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






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






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






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






17. 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






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






19. 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;






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






21. Medical report substantiating a medical condition






22. A correctly completed standardized claim






23. 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






24. The provider receives reimbursement directly from the payer.






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






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






27. 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






28. 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;






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






30. Contract out






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






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






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






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






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






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






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






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






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






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






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






42. Organization that accredits clearinghouses






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






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






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






46. Computer to computer data exchange between payer and provider






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






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






49. 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.






50. 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







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