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. Submitted to the payer - but processing is not complete






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






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






4. 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.






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






6. 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






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






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






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






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






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






12. 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.






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






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






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






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






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






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






19. A correctly completed standardized claim






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






21. 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






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






23. Form used to report institutional - facility services.






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






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






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






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






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






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






30. The insurance claim form used to report professional services






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






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






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






35. Contract out






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






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






38. 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.






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






40. 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






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






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






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






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






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






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






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






48. 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.






49. Medical report substantiating a medical condition






50. Person responsible for paying healthcare fees