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Test your basic knowledge |
Health Insurance
Start Test
Study First
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. 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.
Delinquent claim cycle
Unassigned claim
Unbundling
Coinsurance
2. 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
Out-of-pocket payment
Accounts receivable management
Unassigned claim
Open claim
3. Medical report substantiating a medical condition
Claims submission
Delinquent claim cycle
Accounts receivable aging report
Claims attachment
4. 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
Allowed charges
Fair debt collection practicies Act
Chargemaster
Fair credit reporting Act
5. 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.
Common data file
Two-party check
Bad debt
Coordination of benefits (COB)
6. One that has not been paid within a certain time frame; also called delinquent account
Provider Remittance Notice
Accounts receivable aging report
Pre-existing condition
Past-due account
7. Claims for which all processing - including appeals - has been completed.
Encounter form
Closed claim
Litigation
Chargemaster
8. Any medical condition that was diagnosed and or treated within a specified period of time immediately preceding the enrollee's effective date of coverage.
Pre-existing condition
Clean claim
Open claim
Participating provider
9. Establishes the rights. liabilites - and rsponsibilities of participants in electronic funds transfer systems.
Accept assignment
Pre-existing condition
Litigation
Electronic funds transfer ACT
10. Advances through various aging periods( 30 -60 -90 -120) with practices typically focusing internal recovery efforts on older delinquent accounts.
Accounts receivable
CMS-1500
Unassigned claim
Delinquent claim cycle
11. Amount for which the patient is financially responsible before an insurance company provides coverage.
Unbundling
Electronic funds transfer
Electronic claim processing
Deductible
12. Uses a variable-length file format to process transactions for institutional - professional - dental - and drug claims.
Accounts receivable
ANSI ASC X12 standards
Accept assignment
Consumer Credit Protection Act of 1968
13. When the provider agrees to accept what the insurance company allows or aproves as payment in full for the claim
CMS-1500
Accept assignment
Electronic Healthcare Network Accreditation Commission EHNAC
Day sheet
14. 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.
Noncovered benefit
Electronic Healthcare Network Accreditation Commission EHNAC
Claims processing
Covered entity
15. Contracts with a helath insurance plan and accepts whatever the plan pays for procedures or services performed.
Accept assignment
Clean claim
Participating provider
Equal Credit Opportunity ACT
16. System by which payers deposit funds to the providers account electronically.
Past-due account
Claims attachment
Electronic funds transfer
Claims submission
17. Series of fixed length records submitted to payers to bill for health care services.
Closed claim
Outsourcing
Electronic media claim
Open claim
18. The transmission of claims data (electronical or manually) to payers or clearinghouses for processing.
Claims submission
Two-party check
Guarantor
Unauthorized service
19. Is a public or private entity that processes of facilitates the processing of nonstandard data elements into standard data elements.
Encounter form
Coinsurance
Patient account record
Clearinghouse
20. The provider receives reimbursement directly from the payer.
Assignment of benefits
Fair Credit Billing Act
Unbundling
Covered entity
21. Also called a day sheet - a chronological summary of all transactions posted to individual patient ledgers/accounts on a specific day.
Out-of-pocket payment
Clean claim
Accounts receivable aging report
Manual daily accounts receivable journal
22. Theperson eligible to receive healthcare benefits.
Fair Credit Billing Act
Beneficiary
Claims submission
Electronic funds transfer ACT
23. Contract out
CMS-1500
Electronic funds transfer
Downcoding
Outsourcing
24. 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.
Electronic remittance advi
Clearinghouse
Unauthorized service
Outsourcing
25. The insurance claim form used to report professional services
Guarantor
Value-added network (VAN)
CMS-1500
Unauthorized service
26. Legal action to recover a debt; usually a last resort for a medical practice.
Electronic funds transfer ACT
Accept assignment
Assignment of benefits
Litigation
27. A check made out to the patient and the provider.
Noncovered benefit
Beneficiary
Value-added network (VAN)
Two-party check
28. Also called manual daily accounts receivable journal; cronological summary of all transactions posted to individual patient legers/accounts on a specific day.
Claims processing
Day sheet
Claims attachment
Electronic claim processing
29. 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;
Fair Credit and Charge Card Disclosure ACT
Fair debt collection practicies Act
Covered entity
Claims submission
30. Shows the status (by date) of outstanding claims from each payer - as well as payments due from patients
Deductible
Accounts receivable aging report
Downcoding
Bad debt
31. 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
Value-added network (VAN)
Clean claim
Delinquent account
Day sheet
32. Is a past due account; one that has not been paid within a certain time frame.
Fair Credit Billing Act
Claims attachment
Delinquent account
Superbill
33. Person responsible for paying healthcare fees
Outsourcing
Guarantor
Beneficiary
Electronic data interchange EDI
34. Sending data in a standardized machine readable format to an insurance company via disk - telephone or cable.
Deliquent claim
Day sheet
Two-party check
Electronic claim processing
35. The maximum amount a payer will reimburse for each procedure or service - according to the patient's policy.
Outsourcing
Consumer Credit Protection Act of 1968
Day sheet
Allowed charges
36. 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
Electronic funds transfer
Birthday rule
Consumer Credit Protection Act of 1968
Claims adjudication
37. Determines coverage by primary and secondary policies when each parent subscribes to a different health insurance plan.
Birthday rule
Outsourcing
Deliquent claim
Electronic flat file format
38. Accounts receivable that cannot be collected by the provider or a collect agency.
Electronic flat file format
Coordination of benefits (COB)
Bad debt
Outsourcing
39. Computer to computer data exchange between payer and provider
Provider Remittance Notice
Electronic data interchange EDI
Fair credit reporting Act
Deliquent claim
40. Series of fixed length records submitted to payers to bill for health care services.
Electronic flat file format
Electronic remittance advi
Claims adjudication
Out-of-pocket payment
41. Submitted to the payer - but processing is not complete
Encounter form
Consumer Credit Protection Act of 1968
Open claim
Unassigned claim
42. Abstract of all recent claims filed on each patient.
Clean claim
Source document
Common data file
Delinquent account
43. Associated with how an insurance plan is billed-the insurance plan responsible for paying healthcare insurance claims first is considered primary.
Primary insurance
Source document
Electronic flat file format
Claims attachment
44. Sorting claims upon submission to collect and verify information about a patient and provider.
UB-04
Claims processing
Provider Remittance Notice
Open claim
45. Financial record source document used by providers and other personnel to record treated diagnoses and services rendered to the patient during the current encounter.
Fair credit reporting Act
Encounter form
Manual daily accounts receivable journal
Fair debt collection practicies Act
46. 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.
Claims adjudication
Outsourcing
Equal Credit Opportunity ACT
Accept assignment
47. The amount owed to a business for services or goods provided
Accounts receivable
Fair debt collection practicies Act
Coinsurance
Day sheet
48. A routing slip - charge slip - encounter form - or suberbill from which the insurance claim was generated.
Common data file
Patient ledger
UB-04
Source document
49. Assists providers in the collection of appropriate reimbursement for services rendered; includes functions such as insurance verfication/eligibility and preauthorization of services
Unauthorized service
Participating provider
Accounts receivable management
Unassigned claim
50. The percentage the patient pays for covered services after the deductible has been met and the copayment has been paid.
Value-added network (VAN)
Two-party check
Past-due account
Coinsurance