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