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






2. A correctly completed standardized claim






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






4. Person responsible for paying healthcare fees






5. Assists providers in the collection of appropriate reimbursement for services rendered; includes functions such as insurance verfication/eligibility and preauthorization of services






6. Theperson eligible to receive healthcare benefits.






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






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






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






10. 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.






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






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






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






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






15. 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.






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






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






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






19. Computer to computer data exchange between payer and provider






20. 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;






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






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






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






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






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






26. 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






27. 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






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






29. 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






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






31. Contract out






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






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






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






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






36. Form used to report institutional - facility services.






37. Organization that accredits clearinghouses






38. 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.






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






40. 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






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






42. 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






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






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






45. Medical report substantiating a medical condition






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






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






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






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






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







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