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. Abstract of all recent claims filed on each patient.






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






3. Theperson eligible to receive healthcare benefits.






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






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






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






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






8. 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






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






10. Computer to computer data exchange between payer and provider






11. 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;






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






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






14. A correctly completed standardized claim






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






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






17. 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






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






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






20. 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






21. 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.






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






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






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






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






26. Person responsible for paying healthcare fees






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






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






29. 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.






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






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






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






33. 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






34. 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.






35. Organization that accredits clearinghouses






36. Contract out






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






38. The insurance claim form used to report professional services






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






40. Form used to report institutional - facility services.






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






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






43. 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






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






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






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






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






48. Medical report substantiating a medical condition






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






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