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. 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.






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






3. Medical report substantiating a medical condition






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






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.






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






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






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.






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






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






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






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






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






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.






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






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






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






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






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






20. The provider receives reimbursement directly from the payer.






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






22. Theperson eligible to receive healthcare benefits.






23. Contract out






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.






25. The insurance claim form used to report professional services






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






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






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






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;






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






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






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






33. Person responsible for paying healthcare fees






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






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






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






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






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






39. Computer to computer data exchange between payer and provider






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






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






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






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






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






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.






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.






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






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






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






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