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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. Submitted to the payer - but processing is not complete
Provider Remittance Notice
Assignment of benefits
Open claim
ANSI ASC X12 standards
2. Person responsible for paying healthcare fees
Open claim
Guarantor
Deductible
Allowed charges
3. Submitting multiple CPT codes when one code could of been submitted.
Out-of-pocket payment
CMS-1500
Coinsurance
Unbundling
4. 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
Downcoding
Patient account record
Primary insurance
Value-added network (VAN)
5. Series of fixed length records submitted to payers to bill for health care services.
Unassigned claim
Electronic funds transfer
Electronic media claim
Fair credit reporting Act
6. Contract out
Electronic funds transfer
Outsourcing
CMS-1500
Past-due account
7. Sending data in a standardized machine readable format to an insurance company via disk - telephone or cable.
Electronic claim processing
Primary insurance
Common data file
Unauthorized service
8. When the provider agrees to accept what the insurance company allows or aproves as payment in full for the claim
Fair Credit Billing Act
Two-party check
Accept assignment
Primary insurance
9. 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
Consumer Credit Protection Act of 1968
Electronic claim processing
Chargemaster
Encounter form
10. Assists providers in the collection of appropriate reimbursement for services rendered; includes functions such as insurance verfication/eligibility and preauthorization of services
Open claim
Accounts receivable management
Deliquent claim
Out-of-pocket payment
11. Health plans - healthcare clearinghouses - government health plans - and any health providers that choose to submit or receive transactions electronically.
Beneficiary
Clean claim
Claims adjudication
Covered entity
12. A correctly completed standardized claim
Accounts receivable
Manual daily accounts receivable journal
Electronic Healthcare Network Accreditation Commission EHNAC
Clean claim
13. The term hospitals use to describe the encounter form.
Unbundling
Manual daily accounts receivable journal
Clean claim
Chargemaster
14. The percentage the patient pays for covered services after the deductible has been met and the copayment has been paid.
Coinsurance
Patient account record
Fair credit reporting Act
Manual daily accounts receivable journal
15. 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
UB-04
Participating provider
Electronic data interchange EDI
16. Series of fixed length records submitted to payers to bill for health care services.
Delinquent account
Value-added network (VAN)
Electronic flat file format
Unauthorized service
17. The transmission of claims data (electronical or manually) to payers or clearinghouses for processing.
Claims submission
Allowed charges
Common data file
Patient ledger
18. Uses a variable-length file format to process transactions for institutional - professional - dental - and drug claims.
ANSI ASC X12 standards
Primary insurance
Noncovered benefit
Patient account record
19. Shows the status (by date) of outstanding claims from each payer - as well as payments due from patients
Accounts receivable aging report
Beneficiary
Electronic funds transfer
Deliquent claim
20. 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
Downcoding
Provider Remittance Notice
Fair credit reporting Act
Manual daily accounts receivable journal
21. The provider receives reimbursement directly from the payer.
Litigation
Coordination of benefits (COB)
Day sheet
Assignment of benefits
22. Assigning lower-level codes then documented in the record.
Litigation
Electronic funds transfer ACT
Claims submission
Downcoding
23. Also called a day sheet - a chronological summary of all transactions posted to individual patient ledgers/accounts on a specific day.
Participating provider
Closed claim
Electronic media claim
Manual daily accounts receivable journal
24. Contracts with a helath insurance plan and accepts whatever the plan pays for procedures or services performed.
Participating provider
Guarantor
Claims adjudication
Bad debt
25. Services that are provided to a patient without proper authorization or that are not covered by a current authorization.
Assignment of benefits
Chargemaster
Clean claim
Unauthorized service
26. 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
Open claim
Unbundling
Chargemaster
27. Computer to computer data exchange between payer and provider
Electronic data interchange EDI
Electronic flat file format
Two-party check
Fair debt collection practicies Act
28. Associated with how an insurance plan is billed-the insurance plan responsible for paying healthcare insurance claims first is considered primary.
Primary insurance
Birthday rule
Bad debt
Fair Credit Billing Act
29. Is a past due account; one that has not been paid within a certain time frame.
Pre-existing condition
Delinquent account
Birthday rule
Fair debt collection practicies Act
30. Claims for which all processing - including appeals - has been completed.
Beneficiary
Outsourcing
Closed claim
Electronic funds transfer ACT
31. Organization that accredits clearinghouses
Consumer Credit Protection Act of 1968
Electronic claim processing
Electronic Healthcare Network Accreditation Commission EHNAC
Encounter form
32. Specifies what a collection source may or may not do when pursuing payment on past due accounts.
Electronic remittance advi
Unbundling
Provider Remittance Notice
Fair debt collection practicies Act
33. 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.
Superbill
Noncovered benefit
Open claim
Participating provider
34. Abstract of all recent claims filed on each patient.
Common data file
Delinquent account
Electronic funds transfer
Two-party check
35. Does not contract with the insurance plan; patient who elects to recieve care from nonPARS will incur higher out-of-pocket expenses.
Nonparticipating provider
Coinsurance
Guarantor
Value-added network (VAN)
36. The maximum amount a payer will reimburse for each procedure or service - according to the patient's policy.
Birthday rule
Allowed charges
Fair Credit and Charge Card Disclosure ACT
Superbill
37. Medical report substantiating a medical condition
Electronic media claim
Past-due account
Claims attachment
Birthday rule
38. Sorting claims upon submission to collect and verify information about a patient and provider.
Electronic media claim
Claims processing
Assignment of benefits
Coordination of benefits (COB)
39. One that has not been paid within a certain time frame; also called delinquent account
Electronic funds transfer ACT
Past-due account
Provider Remittance Notice
Electronic Healthcare Network Accreditation Commission EHNAC
40. 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
Open claim
Out-of-pocket payment
Accounts receivable
Assignment of benefits
41. Advances through various aging periods( 30 -60 -90 -120) with practices typically focusing internal recovery efforts on older delinquent accounts.
Noncovered benefit
Assignment of benefits
Fair Credit Billing Act
Delinquent claim cycle
42. System by which payers deposit funds to the providers account electronically.
Electronic Healthcare Network Accreditation Commission EHNAC
Coinsurance
Electronic funds transfer
UB-04
43. Term used for the encounter form in the physicians's office.
Unbundling
Superbill
Patient account record
Electronic Healthcare Network Accreditation Commission EHNAC
44. Establishes the rights. liabilites - and rsponsibilities of participants in electronic funds transfer systems.
Unauthorized service
Clean claim
Electronic flat file format
Electronic funds transfer ACT
45. 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.
Covered entity
Patient account record
Equal Credit Opportunity ACT
Delinquent claim cycle
46. Legal action to recover a debt; usually a last resort for a medical practice.
Covered entity
Litigation
Accept assignment
Bad debt
47. Financial record source document used by providers and other personnel to record treated diagnoses and services rendered to the patient during the current encounter.
Encounter form
Deliquent claim
Claims attachment
Accept assignment
48. Accounts receivable that cannot be collected by the provider or a collect agency.
Equal Credit Opportunity ACT
Bad debt
Delinquent claim cycle
Two-party check
49. The insurance claim form used to report professional services
Claims submission
Noncovered benefit
Outsourcing
CMS-1500
50. A check made out to the patient and the provider.
Two-party check
Delinquent claim cycle
Noncovered benefit
Fair credit reporting Act