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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. A correctly completed standardized claim






2. 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;






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






4. Advances through various aging periods( 30 -60 -90 -120) with practices typically focusing internal recovery efforts on older delinquent accounts.






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






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






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






8. 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.






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






10. Computer to computer data exchange between payer and provider






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






12. Person responsible for paying healthcare fees






13. Contract out






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






15. Series of fixed length records submitted to payers to bill for health care 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. Submitting multiple CPT codes when one code could of been submitted.






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






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






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






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






22. Medical report substantiating a medical condition






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






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






25. 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






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






27. 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.






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






29. 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.






30. The provider receives reimbursement directly from the payer.






31. Form used to report institutional - facility services.






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






33. Theperson eligible to receive healthcare benefits.






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






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






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






37. 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






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






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






40. 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






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






42. 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.






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






44. Organization that accredits clearinghouses






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






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






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






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






49. The insurance claim form used to report professional services






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







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