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. 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;






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






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






4. The insurance claim form used to report professional services






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.






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






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






8. 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






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






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






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






12. The provider receives reimbursement directly from the payer.






13. A computerized permanent record of all financial transactions between the patient and the pratice - also called patient ledger.






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






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






16. 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






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






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






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






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






21. 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.






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. Submitted to the payer - but processing is not complete






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






25. 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.






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






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






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






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






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






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






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






33. Person responsible for paying healthcare fees






34. Form used to report institutional - facility services.






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






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






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






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






39. 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






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






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






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






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






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






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






46. 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






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






48. Organization that accredits clearinghouses






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






50. 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.