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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. Shows the status (by date) of outstanding claims from each payer - as well as payments due from patients
Consumer Credit Protection Act of 1968
Accounts receivable aging report
Electronic funds transfer
Accounts receivable
2. The insurance claim form used to report professional services
Electronic claim processing
CMS-1500
Electronic remittance advi
Provider Remittance Notice
3. A claim that is usually more than 120 days past due; some practices establish time frames that are less than 120 days.
Unbundling
Deliquent claim
Superbill
Fair credit reporting Act
4. 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
Claims processing
Accounts receivable
Bad debt
5. Series of fixed length records submitted to payers to bill for health care services.
Electronic media claim
Superbill
Electronic remittance advi
UB-04
6. The percentage the patient pays for covered services after the deductible has been met and the copayment has been paid.
Coinsurance
Clean claim
Noncovered benefit
Manual daily accounts receivable journal
7. Specifies what a collection source may or may not do when pursuing payment on past due accounts.
Fair Credit Billing Act
Unassigned claim
Fair debt collection practicies Act
Electronic Healthcare Network Accreditation Commission EHNAC
8. Sending data in a standardized machine readable format to an insurance company via disk - telephone or cable.
Clean claim
Electronic claim processing
Fair Credit and Charge Card Disclosure ACT
Allowed charges
9. Is a past due account; one that has not been paid within a certain time frame.
Litigation
Accounts receivable
Delinquent account
Claims adjudication
10. The transmission of claims data (electronical or manually) to payers or clearinghouses for processing.
Electronic remittance advi
Deliquent claim
Noncovered benefit
Claims submission
11. 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
Manual daily accounts receivable journal
Out-of-pocket payment
Coinsurance
Electronic claim processing
12. Medical report substantiating a medical condition
Beneficiary
Electronic data interchange EDI
Claims processing
Claims attachment
13. A correctly completed standardized claim
Encounter form
Fair Credit Billing Act
Clean claim
CMS-1500
14. The amount owed to a business for services or goods provided
Accounts receivable
Fair debt collection practicies Act
Claims adjudication
Guarantor
15. Associated with how an insurance plan is billed-the insurance plan responsible for paying healthcare insurance claims first is considered primary.
Primary insurance
Accounts receivable aging report
Accept assignment
Unbundling
16. Term used for the encounter form in the physicians's office.
Claims adjudication
Delinquent account
Superbill
Noncovered benefit
17. Financial record source document used by providers and other personnel to record treated diagnoses and services rendered to the patient during the current encounter.
Encounter form
Electronic Healthcare Network Accreditation Commission EHNAC
Source document
Accept assignment
18. Assigning lower-level codes then documented in the record.
Downcoding
Electronic funds transfer
Accounts receivable management
Superbill
19. Establishes the rights. liabilites - and rsponsibilities of participants in electronic funds transfer systems.
Patient ledger
Electronic funds transfer ACT
Provider Remittance Notice
Clean claim
20. Abstract of all recent claims filed on each patient.
Claims attachment
Patient account record
Primary insurance
Common data file
21. 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
Day sheet
Value-added network (VAN)
Patient ledger
Closed claim
22. 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
Nonparticipating provider
CMS-1500
Unauthorized service
23. 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.
Value-added network (VAN)
Electronic remittance advi
Fair credit reporting Act
Coinsurance
24. Series of fixed length records submitted to payers to bill for health care services.
Noncovered benefit
Claims adjudication
Electronic flat file format
Two-party check
25. Submitting multiple CPT codes when one code could of been submitted.
Electronic flat file format
Unbundling
Litigation
Clean claim
26. 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
Source document
Fair credit reporting Act
Bad debt
27. Form used to report institutional - facility services.
UB-04
Participating provider
Consumer Credit Protection Act of 1968
Guarantor
28. Uses a variable-length file format to process transactions for institutional - professional - dental - and drug claims.
Clearinghouse
ANSI ASC X12 standards
Accept assignment
Chargemaster
29. Accounts receivable that cannot be collected by the provider or a collect agency.
Participating provider
Open claim
Two-party check
Bad debt
30. Computer to computer data exchange between payer and provider
Unassigned claim
Two-party check
Electronic data interchange EDI
CMS-1500
31. Is a public or private entity that processes of facilitates the processing of nonstandard data elements into standard data elements.
Clearinghouse
Claims submission
Manual daily accounts receivable journal
Provider Remittance Notice
32. Person responsible for paying healthcare fees
Accounts receivable
Guarantor
Nonparticipating provider
Chargemaster
33. 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
Fair debt collection practicies Act
Deductible
Unassigned claim
34. Contract out
Open claim
Electronic media claim
Fair Credit Billing Act
Outsourcing
35. Theperson eligible to receive healthcare benefits.
Downcoding
Allowed charges
Pre-existing condition
Beneficiary
36. System by which payers deposit funds to the providers account electronically.
Electronic funds transfer
Unbundling
Fair credit reporting Act
Consumer Credit Protection Act of 1968
37. Claims for which all processing - including appeals - has been completed.
Fair Credit Billing Act
Deliquent claim
Closed claim
Coordination of benefits (COB)
38. Services that are provided to a patient without proper authorization or that are not covered by a current authorization.
Participating provider
Pre-existing condition
Birthday rule
Unauthorized service
39. The provider receives reimbursement directly from the payer.
Litigation
Assignment of benefits
Bad debt
Nonparticipating provider
40. Sorting claims upon submission to collect and verify information about a patient and provider.
Primary insurance
Deductible
Claims processing
Claims adjudication
41. Also called manual daily accounts receivable journal; cronological summary of all transactions posted to individual patient legers/accounts on a specific day.
Value-added network (VAN)
Manual daily accounts receivable journal
Day sheet
Accounts receivable management
42. The term hospitals use to describe the encounter form.
Accounts receivable aging report
Chargemaster
Litigation
Electronic remittance advi
43. Amount for which the patient is financially responsible before an insurance company provides coverage.
Pre-existing condition
Deductible
Patient ledger
Clearinghouse
44. When the provider agrees to accept what the insurance company allows or aproves as payment in full for the claim
Accept assignment
Patient account record
Nonparticipating provider
Electronic remittance advi
45. Legal action to recover a debt; usually a last resort for a medical practice.
Closed claim
Consumer Credit Protection Act of 1968
Litigation
Value-added network (VAN)
46. A check made out to the patient and the provider.
Two-party check
Birthday rule
Fair debt collection practicies Act
Closed claim
47. Contracts with a helath insurance plan and accepts whatever the plan pays for procedures or services performed.
Electronic media claim
Fair debt collection practicies Act
Participating provider
Pre-existing condition
48. 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.
Fair Credit Billing Act
Unassigned claim
Downcoding
Noncovered benefit
49. Health plans - healthcare clearinghouses - government health plans - and any health providers that choose to submit or receive transactions electronically.
Delinquent account
Coordination of benefits (COB)
Covered entity
Consumer Credit Protection Act of 1968
50. 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
Fair Credit Billing Act
Consumer Credit Protection Act of 1968
Electronic funds transfer ACT
Equal Credit Opportunity ACT