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. Form used to report institutional - facility services.






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






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






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






5. 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.






6. 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






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






8. 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






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






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






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






12. 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






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






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






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






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






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






18. The insurance claim form used to report professional services






19. Organization that accredits clearinghouses






20. Computer to computer data exchange between payer and provider






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






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






23. A correctly completed standardized claim






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






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






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






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






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






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






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






31. 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.






32. Medical report substantiating a medical condition






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






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






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






36. 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;






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






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






39. 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.






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






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






42. 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.






43. Contract out






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






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






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






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






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






49. 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;






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