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






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






3. Medical report substantiating a medical condition






4. The insurance claim form used to report professional services






5. A correctly completed standardized claim






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






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






8. 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.






9. 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.






10. 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.






11. Computer to computer data exchange between payer and provider






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






13. Organization that accredits clearinghouses






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






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






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






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






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






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






20. Person responsible for paying healthcare fees






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






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






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






24. The provider receives reimbursement directly from the payer.






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






26. 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






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






28. 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;






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






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






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






32. 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






33. 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






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






35. Theperson eligible to receive healthcare benefits.






36. 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






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






38. Contract out






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






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






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






42. 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;






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






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






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






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






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






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






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






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