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






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






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






4. 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.






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






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






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






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;






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






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






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






12. Organization that accredits clearinghouses






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






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






15. Medical report substantiating a medical condition






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






17. 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.






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






19. The insurance claim form used to report professional services






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






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






22. 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






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






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






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






26. Computer to computer data exchange between payer and provider






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






28. A correctly completed standardized claim






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






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






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






32. 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.






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






34. Form used to report institutional - facility services.






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






36. Submitted to the payer - but processing is not complete






37. 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






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






39. 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






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






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






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






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






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






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






46. The provider receives reimbursement directly from the payer.






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






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






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






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