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. Computer to computer data exchange between payer and provider






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






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






4. Organization that accredits clearinghouses






5. Theperson eligible to receive healthcare benefits.






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






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






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






9. Medical report substantiating a medical condition






10. 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;






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






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






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






14. 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.






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






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






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






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






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






20. 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.






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






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






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






24. Form used to report institutional - facility services.






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






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






27. 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






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






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






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






31. 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;






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






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






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






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






36. The provider receives reimbursement directly from the payer.






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






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






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






40. 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.






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






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






43. 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






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






45. 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.






46. 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






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






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






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






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