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






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. Theperson eligible to receive healthcare benefits.






4. 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.






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






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






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






8. A correctly completed standardized claim






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






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






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






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






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






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






15. The provider receives reimbursement directly from the payer.






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






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






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






19. 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






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






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






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






23. 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.






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






25. 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






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






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






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






29. The insurance claim form used to report professional services






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






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






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






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






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






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






36. 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.






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






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






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






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






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






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






43. 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;






44. Medical report substantiating a medical condition






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






47. 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






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






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






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