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 correctly completed standardized claim






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






3. 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






4. Computer to computer data exchange between payer and provider






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






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






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






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






9. 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.






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






11. 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.






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






13. 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;






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






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






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






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






18. The provider receives reimbursement directly from the payer.






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






20. The insurance claim form used to report professional services






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






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






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






24. 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.






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






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






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






28. Organization that accredits clearinghouses






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






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






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






32. Contract out






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






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






35. The amount owed to a business for services or goods provided






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






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






38. Theperson eligible to receive healthcare benefits.






39. Medical report substantiating a medical condition






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






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






42. 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.






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






44. Person responsible for paying healthcare fees






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






46. 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;






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






48. 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.






49. 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






50. Form used to report institutional - facility services.