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






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






3. 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.






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






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






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






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






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






9. Person responsible for paying healthcare fees






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






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






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






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






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






15. A correctly completed standardized claim






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






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






18. 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.






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






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






21. Medical report substantiating a medical condition






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






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






24. Computer to computer data exchange between payer and provider






25. 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






26. The provider receives reimbursement directly from the payer.






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






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






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






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






31. Theperson eligible to receive healthcare benefits.






32. 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






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






34. The insurance claim form used to report professional services






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






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






37. 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;






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






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






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






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






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






43. Form used to report institutional - facility services.






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






45. 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.






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






47. 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






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






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






50. 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