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






2. 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.






3. 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.






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






5. Organization that accredits clearinghouses






6. 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






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






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






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






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






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






12. 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;






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






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






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






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






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






18. 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.






19. 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






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






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






22. Computer to computer data exchange between payer and provider






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






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






25. Form used to report institutional - facility services.






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






27. The insurance claim form used to report professional services






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






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






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






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






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






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






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






35. Contract out






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






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






38. 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






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






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






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






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






43. Person responsible for paying healthcare fees






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






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






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






47. 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






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






49. 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.






50. A correctly completed standardized claim