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






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






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






4. 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.






5. 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.






6. Contract out






7. The provider receives reimbursement directly from the payer.






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






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






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






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






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






13. A correctly completed standardized claim






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






15. Theperson eligible to receive healthcare benefits.






16. Person responsible for paying healthcare fees






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






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






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






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






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






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






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






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






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






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






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






28. 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.






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






30. 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






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






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






33. Organization that accredits clearinghouses






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






35. 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;






36. 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






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






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






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






40. 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.






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






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






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






44. 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






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






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






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






48. Medical report substantiating a medical condition






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






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