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






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






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






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






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






6. The provider receives reimbursement directly from the payer.






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






8. 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.






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






10. 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






11. 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






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






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






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






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






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






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






20. Contract out






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






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






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






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






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






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






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






28. Organization that accredits clearinghouses






29. 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






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






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






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






33. 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






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






35. 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;






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






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






38. 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;






39. Medical report substantiating a medical condition






40. 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.






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






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






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






44. Person responsible for paying healthcare fees






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






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






47. The insurance claim form used to report professional services






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






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






50. 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.