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Health Insurance

Subject : industries
  • Answer 50 questions in 15 minutes.
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  • 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. Also called manual daily accounts receivable journal; cronological summary of all transactions posted to individual patient legers/accounts on a specific day.

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

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

4. Theperson eligible to receive healthcare benefits.

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

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

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

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

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

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

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

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

13. 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.

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

15. A computerized permanent record of all financial transactions between the patient and the pratice - also called patient ledger.

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

17. Form used to report institutional - facility services.

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

19. 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.

20. 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

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

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

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

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

25. 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.

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

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

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

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

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

31. The provider receives reimbursement directly from the payer.

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

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

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

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

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

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

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

39. 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

40. 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.

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

42. Medical report substantiating a medical condition

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

44. 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;

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

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

47. 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;

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

50. A correctly completed standardized claim