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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. Series of fixed length records submitted to payers to bill for health care services.
Electronic media claim
Unauthorized service
Superbill
Fair credit reporting Act
2. Legal action to recover a debt; usually a last resort for a medical practice.
Unbundling
Litigation
Claims submission
Electronic media claim
3. Specifies what a collection source may or may not do when pursuing payment on past due accounts.
Fair debt collection practicies Act
Common data file
Pre-existing condition
Chargemaster
4. 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
Out-of-pocket payment
Covered entity
Fair debt collection practicies Act
Claims processing
5. Establishes the rights. liabilites - and rsponsibilities of participants in electronic funds transfer systems.
Nonparticipating provider
Accounts receivable aging report
Fair Credit and Charge Card Disclosure ACT
Electronic funds transfer ACT
6. The insurance claim form used to report professional services
CMS-1500
Covered entity
Encounter form
Pre-existing condition
7. 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.
Electronic remittance advi
Electronic claim processing
Clearinghouse
Covered entity
8. 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
Allowed charges
Litigation
Open claim
9. 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.
Past-due account
Noncovered benefit
Encounter form
Superbill
10. Sorting claims upon submission to collect and verify information about a patient and provider.
Fair Credit and Charge Card Disclosure ACT
Claims processing
Past-due account
Fair Credit Billing Act
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.
Coordination of benefits (COB)
Claims processing
Fair Credit Billing Act
Unassigned claim
12. Does not contract with the insurance plan; patient who elects to recieve care from nonPARS will incur higher out-of-pocket expenses.
Consumer Credit Protection Act of 1968
Common data file
Coinsurance
Nonparticipating provider
13. Also called a day sheet - a chronological summary of all transactions posted to individual patient ledgers/accounts on a specific day.
Claims adjudication
Pre-existing condition
Manual daily accounts receivable journal
ANSI ASC X12 standards
14. One that has not been paid within a certain time frame; also called delinquent account
Coordination of benefits (COB)
Pre-existing condition
Past-due account
Open claim
15. Organization that accredits clearinghouses
Closed claim
UB-04
Delinquent claim cycle
Electronic Healthcare Network Accreditation Commission EHNAC
16. Is a past due account; one that has not been paid within a certain time frame.
Unbundling
Fair credit reporting Act
Pre-existing condition
Delinquent account
17. Form used to report institutional - facility services.
Unassigned claim
Birthday rule
UB-04
Out-of-pocket payment
18. Term used for the encounter form in the physicians's office.
Accept assignment
Pre-existing condition
Superbill
Past-due account
19. Computer to computer data exchange between payer and provider
Noncovered benefit
Deductible
Electronic data interchange EDI
Claims adjudication
20. Advances through various aging periods( 30 -60 -90 -120) with practices typically focusing internal recovery efforts on older delinquent accounts.
Delinquent claim cycle
Fair debt collection practicies Act
Fair Credit Billing Act
Common data file
21. A computerized permanent record of all financial transactions between the patient and the practice;also called patient account record.
Source document
Primary insurance
Patient ledger
Electronic remittance advi
22. The transmission of claims data (electronical or manually) to payers or clearinghouses for processing.
Coinsurance
Claims submission
Value-added network (VAN)
Fair Credit and Charge Card Disclosure ACT
23. Sending data in a standardized machine readable format to an insurance company via disk - telephone or cable.
Assignment of benefits
Electronic claim processing
Electronic funds transfer ACT
Unauthorized service
24. System by which payers deposit funds to the providers account electronically.
Electronic funds transfer
Fair Credit and Charge Card Disclosure ACT
Accounts receivable management
Electronic media claim
25. 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.
Litigation
Electronic funds transfer
Coordination of benefits (COB)
Clean claim
26. A claim that is usually more than 120 days past due; some practices establish time frames that are less than 120 days.
Accounts receivable management
Electronic funds transfer ACT
Deliquent claim
Fair Credit Billing Act
27. Services that are provided to a patient without proper authorization or that are not covered by a current authorization.
Electronic funds transfer
Unauthorized service
Electronic claim processing
Claims adjudication
28. Contracts with a helath insurance plan and accepts whatever the plan pays for procedures or services performed.
Electronic Healthcare Network Accreditation Commission EHNAC
Birthday rule
Outsourcing
Participating provider
29. The percentage the patient pays for covered services after the deductible has been met and the copayment has been paid.
Electronic funds transfer ACT
Fair debt collection practicies Act
Consumer Credit Protection Act of 1968
Coinsurance
30. The term hospitals use to describe the encounter form.
Chargemaster
Fair debt collection practicies Act
Unbundling
Pre-existing condition
31. 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
Covered entity
Electronic flat file format
Equal Credit Opportunity ACT
Fair credit reporting Act
32. Submitted to the payer - but processing is not complete
Open claim
CMS-1500
Delinquent account
Birthday rule
33. 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
Pre-existing condition
UB-04
Value-added network (VAN)
Claims attachment
34. Uses a variable-length file format to process transactions for institutional - professional - dental - and drug claims.
ANSI ASC X12 standards
Unassigned claim
Equal Credit Opportunity ACT
Primary insurance
35. 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
Outsourcing
Closed claim
Accounts receivable aging report
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.
Equal Credit Opportunity ACT
Beneficiary
Deductible
Claims processing
37. Any medical condition that was diagnosed and or treated within a specified period of time immediately preceding the enrollee's effective date of coverage.
Pre-existing condition
Consumer Credit Protection Act of 1968
Deliquent claim
Nonparticipating provider
38. Person responsible for paying healthcare fees
Guarantor
Electronic data interchange EDI
Electronic Healthcare Network Accreditation Commission EHNAC
Accounts receivable
39. A correctly completed standardized claim
Closed claim
Clean claim
Electronic Healthcare Network Accreditation Commission EHNAC
Electronic data interchange EDI
40. Health plans - healthcare clearinghouses - government health plans - and any health providers that choose to submit or receive transactions electronically.
Deliquent claim
Clearinghouse
Deductible
Covered entity
41. Determines coverage by primary and secondary policies when each parent subscribes to a different health insurance plan.
Coordination of benefits (COB)
Birthday rule
Electronic funds transfer ACT
Source document
42. Shows the status (by date) of outstanding claims from each payer - as well as payments due from patients
Fair credit reporting Act
Claims submission
Unbundling
Accounts receivable aging report
43. A routing slip - charge slip - encounter form - or suberbill from which the insurance claim was generated.
Electronic media claim
Source document
Downcoding
Out-of-pocket payment
44. 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
Birthday rule
Downcoding
Electronic funds transfer
Claims adjudication
45. Amount for which the patient is financially responsible before an insurance company provides coverage.
Day sheet
Unbundling
Deductible
Covered entity
46. Abstract of all recent claims filed on each patient.
Common data file
UB-04
Out-of-pocket payment
Electronic funds transfer
47. Also called manual daily accounts receivable journal; cronological summary of all transactions posted to individual patient legers/accounts on a specific day.
Day sheet
Consumer Credit Protection Act of 1968
Covered entity
Electronic Healthcare Network Accreditation Commission EHNAC
48. Series of fixed length records submitted to payers to bill for health care services.
Electronic data interchange EDI
Electronic funds transfer
Fair credit reporting Act
Electronic flat file format
49. Assigning lower-level codes then documented in the record.
Fair debt collection practicies Act
Downcoding
Allowed charges
Two-party check
50. Contract out
Out-of-pocket payment
Pre-existing condition
Outsourcing
ANSI ASC X12 standards