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






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






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






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






5. Organization that accredits clearinghouses






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






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






8. 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.






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






10. 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






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






12. Person responsible for paying healthcare fees






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






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






15. Medical report substantiating a medical condition






16. 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






17. A computerized permanent record of all financial transactions between the patient and the pratice - also called patient ledger.






18. 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.






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






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






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






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






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






24. Remittance advice submitted by Medicare to providers that includes payment information about a claim.






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






26. Form used to report institutional - facility services.






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






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






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






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






31. A correctly completed standardized claim






32. Computer to computer data exchange between payer and provider






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






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






35. The insurance claim form used to report professional services






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






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






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






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






40. Contract out






41. 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






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






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






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






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






46. 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.






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






48. 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.






49. 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






50. 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






Can you answer 50 questions in 15 minutes?



Let me suggest you:

Browse all subjects

Browse all tests

Most popular tests



Major Subjects

Tests & Exams


AP
CLEP
DSST
GRE
SAT
GMAT

Browse all subjects

Browse all tests

Most popular tests