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






2. Person responsible for paying healthcare fees






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






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






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






6. 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;






7. Medical report substantiating a medical condition






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






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






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






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






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






14. A claim that is usually more than 120 days past due; some practices establish time frames that are less than 120 days.






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






16. A correctly completed standardized claim






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






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






19. Theperson eligible to receive healthcare benefits.






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






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






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






23. 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.






24. The insurance claim form used to report professional 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. Also called a day sheet - a chronological summary of all transactions posted to individual patient ledgers/accounts on a specific day.






27. Computer to computer data exchange between payer and provider






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






29. 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.






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






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






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






33. 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






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






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






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






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






38. Contract out






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






40. 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.






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






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






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






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






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






46. 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






47. 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.






48. Form used to report institutional - facility services.






49. 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






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







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