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






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






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






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






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






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






7. 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.






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






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






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






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






12. 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






13. Computer to computer data exchange between payer and provider






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






15. Theperson eligible to receive healthcare benefits.






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






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






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






19. 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






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






21. 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.






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






23. 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






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






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






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






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






28. 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.






29. Organization that accredits clearinghouses






30. Medical report substantiating a medical condition






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






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






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






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






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






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






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






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






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






40. The provider receives reimbursement directly from the payer.






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






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






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






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






45. Person responsible for paying healthcare fees






46. Contract out






47. The insurance claim form used to report professional services






48. 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






49. 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.






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