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Test your basic knowledge |
Health Insurance
Start Test
Study First
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. Form used to report institutional - facility services.
Electronic remittance advi
Provider Remittance Notice
UB-04
Out-of-pocket payment
2. Does not contract with the insurance plan; patient who elects to recieve care from nonPARS will incur higher out-of-pocket expenses.
Clearinghouse
Past-due account
Nonparticipating provider
Electronic flat file format
3. Specifies what a collection source may or may not do when pursuing payment on past due accounts.
Unbundling
Claims submission
Fair debt collection practicies Act
Accounts receivable aging report
4. System by which payers deposit funds to the providers account electronically.
Claims adjudication
Electronic funds transfer
Fair credit reporting Act
Fair Credit Billing Act
5. 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.
Deliquent claim
Out-of-pocket payment
Equal Credit Opportunity ACT
Fair Credit Billing Act
6. 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
Deliquent claim
Electronic funds transfer ACT
Fair credit reporting Act
Superbill
7. A routing slip - charge slip - encounter form - or suberbill from which the insurance claim was generated.
Fair debt collection practicies Act
Source document
CMS-1500
Electronic media claim
8. 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
Claims adjudication
Allowed charges
Fair Credit and Charge Card Disclosure ACT
Claims submission
9. Determines coverage by primary and secondary policies when each parent subscribes to a different health insurance plan.
Unassigned claim
Litigation
Day sheet
Birthday rule
10. One that has not been paid within a certain time frame; also called delinquent account
Chargemaster
Covered entity
Closed claim
Past-due account
11. Sorting claims upon submission to collect and verify information about a patient and provider.
Accounts receivable management
Beneficiary
Out-of-pocket payment
Claims processing
12. 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
Beneficiary
Deductible
Downcoding
Consumer Credit Protection Act of 1968
13. Legal action to recover a debt; usually a last resort for a medical practice.
Outsourcing
Litigation
Assignment of benefits
Electronic media claim
14. Remittance advice submitted by Medicare to providers that includes payment information about a claim.
Accounts receivable aging report
Primary insurance
Fair Credit Billing Act
Provider Remittance Notice
15. Uses a variable-length file format to process transactions for institutional - professional - dental - and drug claims.
Superbill
Consumer Credit Protection Act of 1968
Accounts receivable aging report
ANSI ASC X12 standards
16. Any medical condition that was diagnosed and or treated within a specified period of time immediately preceding the enrollee's effective date of coverage.
Encounter form
Fair credit reporting Act
Pre-existing condition
Deliquent claim
17. Accounts receivable that cannot be collected by the provider or a collect agency.
Bad debt
Fair Credit and Charge Card Disclosure ACT
Unassigned claim
Nonparticipating provider
18. The insurance claim form used to report professional services
Clearinghouse
Electronic funds transfer ACT
Accept assignment
CMS-1500
19. Organization that accredits clearinghouses
Electronic Healthcare Network Accreditation Commission EHNAC
Claims adjudication
Outsourcing
Accept assignment
20. Computer to computer data exchange between payer and provider
Electronic data interchange EDI
Patient ledger
Two-party check
Guarantor
21. Assists providers in the collection of appropriate reimbursement for services rendered; includes functions such as insurance verfication/eligibility and preauthorization of services
Coordination of benefits (COB)
Fair Credit Billing Act
Accounts receivable management
Litigation
22. Shows the status (by date) of outstanding claims from each payer - as well as payments due from patients
Equal Credit Opportunity ACT
Accounts receivable aging report
Unauthorized service
Past-due account
23. A correctly completed standardized claim
Source document
Litigation
Electronic claim processing
Clean claim
24. The transmission of claims data (electronical or manually) to payers or clearinghouses for processing.
Fair Credit Billing Act
Deductible
Claims submission
Participating provider
25. Submitting multiple CPT codes when one code could of been submitted.
Common data file
Claims processing
Unbundling
Value-added network (VAN)
26. The percentage the patient pays for covered services after the deductible has been met and the copayment has been paid.
Provider Remittance Notice
Open claim
Patient ledger
Coinsurance
27. When the provider agrees to accept what the insurance company allows or aproves as payment in full for the claim
Unassigned claim
Source document
Clearinghouse
Accept assignment
28. Also called a day sheet - a chronological summary of all transactions posted to individual patient ledgers/accounts on a specific day.
Electronic flat file format
Noncovered benefit
Accounts receivable management
Manual daily accounts receivable journal
29. The maximum amount a payer will reimburse for each procedure or service - according to the patient's policy.
Allowed charges
Delinquent claim cycle
Past-due account
Deliquent claim
30. Abstract of all recent claims filed on each patient.
Electronic flat file format
Coinsurance
Common data file
Value-added network (VAN)
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.
Coordination of benefits (COB)
Unassigned claim
Noncovered benefit
Beneficiary
32. Medical report substantiating a medical condition
Fair Credit Billing Act
Claims attachment
Accept assignment
Beneficiary
33. Claims for which all processing - including appeals - has been completed.
Electronic funds transfer ACT
Chargemaster
Closed claim
Unauthorized service
34. Is a past due account; one that has not been paid within a certain time frame.
Encounter form
Delinquent account
Patient account record
Claims attachment
35. Assigning lower-level codes then documented in the record.
Claims attachment
Past-due account
Litigation
Downcoding
36. 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;
Fair Credit and Charge Card Disclosure ACT
Manual daily accounts receivable journal
Electronic media claim
Claims submission
37. Financial record source document used by providers and other personnel to record treated diagnoses and services rendered to the patient during the current encounter.
Value-added network (VAN)
Allowed charges
Unbundling
Encounter form
38. Amount for which the patient is financially responsible before an insurance company provides coverage.
Nonparticipating provider
Deductible
Consumer Credit Protection Act of 1968
Provider Remittance Notice
39. 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.
Electronic media claim
Unassigned claim
Accounts receivable
ANSI ASC X12 standards
40. Contracts with a helath insurance plan and accepts whatever the plan pays for procedures or services performed.
Nonparticipating provider
Closed claim
Electronic media claim
Participating provider
41. Services that are provided to a patient without proper authorization or that are not covered by a current authorization.
Coinsurance
UB-04
Unauthorized service
Electronic funds transfer
42. 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.
Litigation
Allowed charges
Noncovered benefit
Accounts receivable
43. Contract out
Outsourcing
Allowed charges
Chargemaster
Coordination of benefits (COB)
44. The amount owed to a business for services or goods provided
Accounts receivable
Accounts receivable management
Clean claim
Noncovered benefit
45. The term hospitals use to describe the encounter form.
Claims processing
Day sheet
Chargemaster
Closed claim
46. Is a public or private entity that processes of facilitates the processing of nonstandard data elements into standard data elements.
Clearinghouse
Open claim
Electronic funds transfer ACT
Claims adjudication
47. A computerized permanent record of all financial transactions between the patient and the practice;also called patient account record.
Unauthorized service
Patient ledger
Unassigned claim
Out-of-pocket payment
48. Series of fixed length records submitted to payers to bill for health care services.
Claims submission
Electronic media claim
ANSI ASC X12 standards
Fair Credit Billing Act
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;
Fair Credit Billing Act
Consumer Credit Protection Act of 1968
Two-party check
UB-04
50. Series of fixed length records submitted to payers to bill for health care services.
Downcoding
Electronic flat file format
Accounts receivable aging report
Accounts receivable management