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Test your basic knowledge |
Health Insurance
Start Test
Study First
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. Organization that accredits clearinghouses
Coinsurance
Guarantor
Bad debt
Electronic Healthcare Network Accreditation Commission EHNAC
2. Uses a variable-length file format to process transactions for institutional - professional - dental - and drug claims.
Electronic funds transfer
Assignment of benefits
ANSI ASC X12 standards
Accounts receivable management
3. The insurance claim form used to report professional services
CMS-1500
Out-of-pocket payment
UB-04
Primary insurance
4. Legal action to recover a debt; usually a last resort for a medical practice.
Delinquent account
Day sheet
Litigation
Birthday rule
5. Assigning lower-level codes then documented in the record.
Downcoding
Primary insurance
Coordination of benefits (COB)
Superbill
6. System by which payers deposit funds to the providers account electronically.
Electronic funds transfer
Claims adjudication
Clearinghouse
Assignment of benefits
7. The amount owed to a business for services or goods provided
Electronic funds transfer
Claims submission
Equal Credit Opportunity ACT
Accounts receivable
8. 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;
Day sheet
Fair Credit and Charge Card Disclosure ACT
Bad debt
Equal Credit Opportunity ACT
9. Sending data in a standardized machine readable format to an insurance company via disk - telephone or cable.
Coordination of benefits (COB)
Value-added network (VAN)
Beneficiary
Electronic claim processing
10. When the provider agrees to accept what the insurance company allows or aproves as payment in full for the claim
Encounter form
Unassigned claim
Coinsurance
Accept assignment
11. A computerized permanent record of all financial transactions between the patient and the practice;also called patient account record.
Patient ledger
Outsourcing
Value-added network (VAN)
Coinsurance
12. 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
Outsourcing
Out-of-pocket payment
Fair credit reporting Act
Two-party check
13. 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
Litigation
Open claim
Fair credit reporting Act
Out-of-pocket payment
14. A check made out to the patient and the provider.
Allowed charges
Two-party check
Electronic flat file format
Value-added network (VAN)
15. 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;
Litigation
Fair Credit Billing Act
Past-due account
Coinsurance
16. 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
Covered entity
Claims adjudication
Consumer Credit Protection Act of 1968
Coordination of benefits (COB)
17. Claims for which all processing - including appeals - has been completed.
Unbundling
Guarantor
Assignment of benefits
Closed claim
18. Health plans - healthcare clearinghouses - government health plans - and any health providers that choose to submit or receive transactions electronically.
Open claim
Coinsurance
Covered entity
Pre-existing condition
19. A claim that is usually more than 120 days past due; some practices establish time frames that are less than 120 days.
Electronic funds transfer
Beneficiary
Deliquent claim
Bad debt
20. Medical report substantiating a medical condition
Participating provider
Claims attachment
Delinquent account
UB-04
21. Form used to report institutional - facility services.
Participating provider
Consumer Credit Protection Act of 1968
Two-party check
UB-04
22. Submitting multiple CPT codes when one code could of been submitted.
Birthday rule
Accounts receivable aging report
Claims attachment
Unbundling
23. Financial record source document used by providers and other personnel to record treated diagnoses and services rendered to the patient during the current encounter.
Superbill
Litigation
Day sheet
Encounter form
24. The transmission of claims data (electronical or manually) to payers or clearinghouses for processing.
Claims submission
Outsourcing
Unauthorized service
Day sheet
25. A routing slip - charge slip - encounter form - or suberbill from which the insurance claim was generated.
Fair Credit Billing Act
Electronic media claim
Source document
Electronic Healthcare Network Accreditation Commission EHNAC
26. Computer to computer data exchange between payer and provider
Outsourcing
Electronic data interchange EDI
Value-added network (VAN)
Litigation
27. Remittance advice submitted by Medicare to providers that includes payment information about a claim.
Unauthorized service
Patient ledger
Equal Credit Opportunity ACT
Provider Remittance Notice
28. Assists providers in the collection of appropriate reimbursement for services rendered; includes functions such as insurance verfication/eligibility and preauthorization of services
Electronic media claim
Coordination of benefits (COB)
Accounts receivable management
Deductible
29. 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.
Deliquent claim
Equal Credit Opportunity ACT
Covered entity
Claims attachment
30. Contracts with a helath insurance plan and accepts whatever the plan pays for procedures or services performed.
ANSI ASC X12 standards
Electronic data interchange EDI
Participating provider
Encounter form
31. 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.
Unauthorized service
Common data file
Noncovered benefit
Pre-existing condition
32. Term used for the encounter form in the physicians's office.
Claims submission
Superbill
Bad debt
Chargemaster
33. Establishes the rights. liabilites - and rsponsibilities of participants in electronic funds transfer systems.
Electronic funds transfer ACT
Patient account record
Electronic media claim
Clean claim
34. The maximum amount a payer will reimburse for each procedure or service - according to the patient's policy.
Claims processing
Unbundling
Allowed charges
Electronic Healthcare Network Accreditation Commission EHNAC
35. Is a public or private entity that processes of facilitates the processing of nonstandard data elements into standard data elements.
Claims processing
Past-due account
Value-added network (VAN)
Clearinghouse
36. Person responsible for paying healthcare fees
Pre-existing condition
Guarantor
Covered entity
Deductible
37. Associated with how an insurance plan is billed-the insurance plan responsible for paying healthcare insurance claims first is considered primary.
Clean claim
Fair credit reporting Act
Delinquent account
Primary insurance
38. Amount for which the patient is financially responsible before an insurance company provides coverage.
Deductible
Two-party check
Electronic media claim
Source document
39. Submitted to the payer - but processing is not complete
Bad debt
Patient account record
Open claim
Outsourcing
40. Accounts receivable that cannot be collected by the provider or a collect agency.
Bad debt
Litigation
Allowed charges
Delinquent account
41. Sorting claims upon submission to collect and verify information about a patient and provider.
Patient ledger
Equal Credit Opportunity ACT
Fair debt collection practicies Act
Claims processing
42. Series of fixed length records submitted to payers to bill for health care services.
ANSI ASC X12 standards
Electronic flat file format
Day sheet
Outsourcing
43. Shows the status (by date) of outstanding claims from each payer - as well as payments due from patients
Pre-existing condition
Manual daily accounts receivable journal
Accounts receivable aging report
Allowed charges
44. The term hospitals use to describe the encounter form.
Unassigned claim
Fair debt collection practicies Act
Fair credit reporting Act
Chargemaster
45. Also called manual daily accounts receivable journal; cronological summary of all transactions posted to individual patient legers/accounts on a specific day.
Day sheet
Accounts receivable aging report
Beneficiary
Pre-existing condition
46. Determines coverage by primary and secondary policies when each parent subscribes to a different health insurance plan.
Litigation
Birthday rule
Delinquent claim cycle
Manual daily accounts receivable journal
47. A correctly completed standardized claim
Accounts receivable management
Clean claim
Patient ledger
Noncovered benefit
48. 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.
Electronic flat file format
Unassigned claim
Open claim
Fair Credit Billing Act
49. 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.
Electronic remittance advi
Past-due account
Unassigned claim
Covered entity
50. Also called a day sheet - a chronological summary of all transactions posted to individual patient ledgers/accounts on a specific day.
Day sheet
Assignment of benefits
Manual daily accounts receivable journal
Participating provider