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






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






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






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






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






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






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. Contract out






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






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






11. 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.






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






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






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






15. Theperson eligible to receive healthcare benefits.






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






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






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






19. The insurance claim form used to report professional services






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






21. Medical report substantiating a medical condition






22. Remittance advice that is submitted to the provider electronically and contains the same information as a paper-based remittance advice; providers receive ERA more quickly.






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






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






25. Form used to report institutional - facility services.






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






27. 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;






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






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






30. 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.






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






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






33. Organization that accredits clearinghouses






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






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






36. 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






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






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






39. 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.






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






41. 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






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






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






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






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






46. 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.






47. 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






48. The provider receives reimbursement directly from the payer.






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






50. 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;