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. Submitted to the payer - but processing is not complete






2. Person responsible for paying healthcare fees






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






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






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






6. Contract out






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






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






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






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






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






12. A correctly completed standardized claim






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






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






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;






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






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






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






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






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






21. The provider receives reimbursement directly from the payer.






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






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






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






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






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.






27. Computer to computer data exchange between payer and provider






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






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






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






31. Organization that accredits clearinghouses






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






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.






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






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






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






37. Medical report substantiating a medical condition






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






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






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






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






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






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






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






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.






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






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.






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






49. The insurance claim form used to report professional services






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