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






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






3. 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






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






5. Organization that accredits clearinghouses






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






7. Person responsible for paying healthcare fees






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






9. 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.






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






11. 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.






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






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






14. Contract out






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






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






17. Computer to computer data exchange between payer and provider






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






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






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






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






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






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






24. 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.






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






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






27. Medical report substantiating a medical condition






28. Form used to report institutional - facility services.






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






30. A correctly completed standardized claim






31. 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






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






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






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






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






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






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






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






39. 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






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






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






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






43. 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.






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






45. 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;






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






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






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






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






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