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Health Insurance

Subject : industries
Instructions:
  • Answer 50 questions in 15 minutes.
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  • 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. 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.






2. 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






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






4. Organization that accredits clearinghouses






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






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






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






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






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






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






11. 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






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






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






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






15. 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






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






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






18. 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.






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






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






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






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






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






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






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






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






27. The provider receives reimbursement directly from the payer.






28. 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;






29. 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;






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






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






32. 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






33. Person responsible for paying healthcare fees






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






35. A correctly completed standardized claim






36. 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.






37. 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.






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






39. Theperson eligible to receive healthcare benefits.






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






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






42. Computer to computer data exchange between payer and provider






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






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






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






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






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






48. Contract out






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






50. Form used to report institutional - facility services.







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