SUBJECTS
|
BROWSE
|
CAREER CENTER
|
POPULAR
|
JOIN
|
LOGIN
Business Skills
|
Soft Skills
|
Basic Literacy
|
Certifications
About
|
Help
|
Privacy
|
Terms
|
Email
Search
Test your basic knowledge |
Health Insurance
Start Test
Study First
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. Is a public or private entity that processes of facilitates the processing of nonstandard data elements into standard data elements.
Clearinghouse
Claims processing
Litigation
Equal Credit Opportunity ACT
2. Remittance advice submitted by Medicare to providers that includes payment information about a claim.
Closed claim
Patient ledger
Provider Remittance Notice
Coinsurance
3. Establishes the rights. liabilites - and rsponsibilities of participants in electronic funds transfer systems.
Electronic funds transfer ACT
Fair Credit Billing Act
Electronic remittance advi
Downcoding
4. Assists providers in the collection of appropriate reimbursement for services rendered; includes functions such as insurance verfication/eligibility and preauthorization of services
Electronic remittance advi
Out-of-pocket payment
Claims adjudication
Accounts receivable management
5. Shows the status (by date) of outstanding claims from each payer - as well as payments due from patients
Value-added network (VAN)
Birthday rule
Accept assignment
Accounts receivable aging report
6. Associated with how an insurance plan is billed-the insurance plan responsible for paying healthcare insurance claims first is considered primary.
Electronic flat file format
Primary insurance
Out-of-pocket payment
Guarantor
7. Assigning lower-level codes then documented in the record.
Downcoding
UB-04
Source document
Claims submission
8. The provider receives reimbursement directly from the payer.
Accounts receivable aging report
Assignment of benefits
Birthday rule
Open claim
9. 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
Source document
Coordination of benefits (COB)
Fair credit reporting Act
Electronic media claim
10. 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
Nonparticipating provider
Outsourcing
Source document
Claims adjudication
11. Submitting multiple CPT codes when one code could of been submitted.
Electronic data interchange EDI
Unbundling
Claims processing
Bad debt
12. A check made out to the patient and the provider.
Covered entity
Downcoding
Two-party check
Unassigned claim
13. Advances through various aging periods( 30 -60 -90 -120) with practices typically focusing internal recovery efforts on older delinquent accounts.
Unauthorized service
Claims attachment
Delinquent claim cycle
Past-due account
14. The amount owed to a business for services or goods provided
Accounts receivable management
Electronic remittance advi
Accounts receivable
Consumer Credit Protection Act of 1968
15. Submitted to the payer - but processing is not complete
Claims attachment
Delinquent claim cycle
Participating provider
Open claim
16. 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
Value-added network (VAN)
Electronic flat file format
Manual daily accounts receivable journal
Out-of-pocket payment
17. Sorting claims upon submission to collect and verify information about a patient and provider.
Claims processing
Coordination of benefits (COB)
Patient ledger
Open claim
18. Determines coverage by primary and secondary policies when each parent subscribes to a different health insurance plan.
Birthday rule
Electronic data interchange EDI
Coinsurance
Assignment of benefits
19. Uses a variable-length file format to process transactions for institutional - professional - dental - and drug claims.
ANSI ASC X12 standards
Two-party check
Past-due account
Bad debt
20. Claims for which all processing - including appeals - has been completed.
Electronic Healthcare Network Accreditation Commission EHNAC
UB-04
Accounts receivable management
Closed claim
21. 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.
Equal Credit Opportunity ACT
Deliquent claim
Electronic remittance advi
Primary insurance
22. Specifies what a collection source may or may not do when pursuing payment on past due accounts.
Covered entity
Patient ledger
Fair debt collection practicies Act
Unauthorized service
23. Form used to report institutional - facility services.
Claims adjudication
Accounts receivable
Clearinghouse
UB-04
24. One that has not been paid within a certain time frame; also called delinquent account
Coinsurance
Deliquent claim
Past-due account
Birthday rule
25. The percentage the patient pays for covered services after the deductible has been met and the copayment has been paid.
Common data file
Coinsurance
Bad debt
Claims attachment
26. Term used for the encounter form in the physicians's office.
Deductible
Source document
Assignment of benefits
Superbill
27. 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;
Fair Credit and Charge Card Disclosure ACT
Noncovered benefit
Equal Credit Opportunity ACT
Accept assignment
28. When the provider agrees to accept what the insurance company allows or aproves as payment in full for the claim
Accounts receivable
Litigation
Accept assignment
Clearinghouse
29. A computerized permanent record of all financial transactions between the patient and the practice;also called patient account record.
Provider Remittance Notice
Patient ledger
Clearinghouse
Unbundling
30. Does not contract with the insurance plan; patient who elects to recieve care from nonPARS will incur higher out-of-pocket expenses.
Encounter form
Fair Credit Billing Act
Electronic Healthcare Network Accreditation Commission EHNAC
Nonparticipating provider
31. Contracts with a helath insurance plan and accepts whatever the plan pays for procedures or services performed.
Participating provider
Fair credit reporting Act
Open claim
Out-of-pocket payment
32. Also called manual daily accounts receivable journal; cronological summary of all transactions posted to individual patient legers/accounts on a specific day.
Claims adjudication
Open claim
Day sheet
Patient ledger
33. Any medical condition that was diagnosed and or treated within a specified period of time immediately preceding the enrollee's effective date of coverage.
Nonparticipating provider
Noncovered benefit
Pre-existing condition
CMS-1500
34. 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.
Source document
Deductible
Electronic remittance advi
Unauthorized service
35. System by which payers deposit funds to the providers account electronically.
Clearinghouse
Electronic funds transfer
Manual daily accounts receivable journal
Outsourcing
36. A computerized permanent record of all financial transactions between the patient and the pratice - also called patient ledger.
Value-added network (VAN)
Clearinghouse
Downcoding
Patient account record
37. Services that are provided to a patient without proper authorization or that are not covered by a current authorization.
Deliquent claim
Unauthorized service
Claims adjudication
Claims processing
38. Series of fixed length records submitted to payers to bill for health care services.
Past-due account
Provider Remittance Notice
Electronic media claim
Common data file
39. Is a past due account; one that has not been paid within a certain time frame.
Delinquent account
Consumer Credit Protection Act of 1968
Closed claim
Fair Credit and Charge Card Disclosure ACT
40. Health plans - healthcare clearinghouses - government health plans - and any health providers that choose to submit or receive transactions electronically.
Deliquent claim
Allowed charges
CMS-1500
Covered entity
41. The transmission of claims data (electronical or manually) to payers or clearinghouses for processing.
Patient account record
Coordination of benefits (COB)
Value-added network (VAN)
Claims submission
42. Amount for which the patient is financially responsible before an insurance company provides coverage.
Claims attachment
Unauthorized service
Patient ledger
Deductible
43. Accounts receivable that cannot be collected by the provider or a collect agency.
Accounts receivable aging report
Superbill
Litigation
Bad debt
44. The term hospitals use to describe the encounter form.
Pre-existing condition
Superbill
Chargemaster
Bad debt
45. Theperson eligible to receive healthcare benefits.
Coinsurance
Clean claim
Beneficiary
Fair Credit and Charge Card Disclosure ACT
46. Contract out
Unassigned claim
Outsourcing
Delinquent account
Claims submission
47. 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.
Noncovered benefit
Electronic funds transfer
Downcoding
Nonparticipating provider
48. Organization that accredits clearinghouses
Accounts receivable management
Downcoding
Value-added network (VAN)
Electronic Healthcare Network Accreditation Commission EHNAC
49. 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
Open claim
Consumer Credit Protection Act of 1968
Electronic media claim
Beneficiary
50. Financial record source document used by providers and other personnel to record treated diagnoses and services rendered to the patient during the current encounter.
Common data file
Consumer Credit Protection Act of 1968
Electronic remittance advi
Encounter form