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Health Insurance

Subject : industries
Instructions:
  • Answer 50 questions in 15 minutes.
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  • 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 provider receives reimbursement directly from the payer.






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






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






4. 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






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






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






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






8. Contract out






9. 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






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






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






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






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






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






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






16. 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;






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






18. 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.






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






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






21. 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






22. 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.






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






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






25. Form used to report institutional - facility services.






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






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






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






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






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






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






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






33. 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.






34. Medical report substantiating a medical condition






35. Theperson eligible to receive healthcare benefits.






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






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






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






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






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






41. 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.






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






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






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






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






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






47. Associated with how an insurance plan is billed-the insurance plan responsible for paying healthcare insurance claims first is considered primary.






48. Computer to computer data exchange between payer and provider






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






50. 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







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