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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. 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






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






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






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






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






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






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






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






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






10. 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






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






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






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






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






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






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






17. Contract out






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






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






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






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






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






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






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






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






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






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






28. Organization that accredits clearinghouses






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






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






31. 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.






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






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






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






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






36. Person responsible for paying healthcare fees






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






38. 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






39. The insurance claim form used to report professional services






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






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






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






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






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






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






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






47. Computer to computer data exchange between payer and provider






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






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






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