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. 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;






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






3. 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






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






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






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






7. 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






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






9. Contract out






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






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






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






13. 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.






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






15. Person responsible for paying healthcare fees






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






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






18. 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






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






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






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






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






23. 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;






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






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






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






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






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






29. 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






30. 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.






31. Medical report substantiating a medical condition






32. 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.






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






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






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






37. Organization that accredits clearinghouses






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






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






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






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






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






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






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






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






46. Computer to computer data exchange between payer and provider






47. Theperson eligible to receive healthcare benefits.






48. A correctly completed standardized claim






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






50. The insurance claim form used to report professional services