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. 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;






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






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






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






5. 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.






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






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






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






9. 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






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






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






12. 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.






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






14. The provider receives reimbursement directly from the payer.






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






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






17. 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






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






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






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






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






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






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






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






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






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






27. 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.






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






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






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






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






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






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






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






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






36. Person responsible for paying healthcare fees






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






38. Organization that accredits clearinghouses






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






40. 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;






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






42. Form used to report institutional - facility services.






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






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






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






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






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






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






49. The insurance claim form used to report professional services






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