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. Organization that accredits clearinghouses






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






3. The insurance claim form used to report professional services






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






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






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






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






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;






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






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






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






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






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






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






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;






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






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






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






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






20. Medical report substantiating a medical condition






21. Form used to report institutional - facility services.






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






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.






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






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






26. Computer to computer data exchange between payer and provider






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






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






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.






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






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.






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






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






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






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






36. Person responsible for paying healthcare fees






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






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






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






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






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






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






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






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






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






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






47. A correctly completed standardized claim






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.






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.






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