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. 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.






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






3. Person responsible for paying healthcare fees






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






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






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






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






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






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






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






11. The insurance claim form used to report professional services






12. Computer to computer data exchange between payer and provider






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






14. 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






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






16. The provider receives reimbursement directly from the payer.






17. Theperson eligible to receive healthcare benefits.






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






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






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






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






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






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. 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;






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






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






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






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. Form used to report institutional - facility services.






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






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






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






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






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






35. 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.






36. 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.






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






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






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






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






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






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






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






44. 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






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






46. Contract out






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






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






49. Organization that accredits clearinghouses






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