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. Does not contract with the insurance plan; patient who elects to recieve care from nonPARS will incur higher out-of-pocket expenses.






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






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






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






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






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






8. 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;






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






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






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






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






13. A correctly completed standardized claim






14. Organization that accredits clearinghouses






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






16. Computer to computer data exchange between payer and provider






17. The provider receives reimbursement directly from the payer.






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






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






20. 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;






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






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






23. Contract out






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






25. 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






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






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






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






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






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






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






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






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






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






35. Theperson eligible to receive healthcare benefits.






36. 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.






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






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






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






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






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






42. A claim that is usually more than 120 days past due; some practices establish time frames that are less than 120 days.






43. 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.






44. 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






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






46. 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






47. 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.






48. 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






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






50. Person responsible for paying healthcare fees