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






2. The provider receives reimbursement directly from the payer.






3. Organization that accredits clearinghouses






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






5. 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.






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






7. 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.






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. Form used to report institutional - facility services.






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






11. Contract out






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






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






14. 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






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






16. Theperson eligible to receive healthcare benefits.






17. Medical report substantiating a medical condition






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






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






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






21. 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.






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






23. Person responsible for paying healthcare fees






24. 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






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






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






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






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






29. 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;






30. The insurance claim form used to report professional services






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






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






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






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






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






36. Sorting claims upon submission to collect and verify information about a patient and 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. Computer to computer data exchange between payer and provider






39. 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.






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






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






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






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






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






45. 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.






46. A correctly completed standardized claim






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






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






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






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