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






2. Computer to computer data exchange between payer and provider






3. 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;






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






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






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






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






8. A correctly completed standardized claim






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






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






11. 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






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






13. 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






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






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






16. 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.






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






18. Form used to report institutional - facility services.






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






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






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






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






23. 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






24. 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






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






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






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






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






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






30. 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.






31. 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.






32. 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;






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






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






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






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






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






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






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






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






41. The provider receives reimbursement directly from the payer.






42. Theperson eligible to receive healthcare benefits.






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






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






45. Person responsible for paying healthcare fees






46. Contract out






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






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






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






50. Medical report substantiating a medical condition