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. 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






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






3. The insurance claim form used to report professional services






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






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






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






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






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






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






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






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






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






13. 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.






14. 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;






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






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






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






18. 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.






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






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






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






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






23. Theperson eligible to receive healthcare benefits.






24. 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;






25. Contract out






26. Organization that accredits clearinghouses






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






28. Form used to report institutional - facility services.






29. Person responsible for paying healthcare fees






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






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






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






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






34. 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.






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






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






37. Computer to computer data exchange between payer and provider






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






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






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






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






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






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






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






45. 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






46. 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






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






48. A correctly completed standardized claim






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






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