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






2. The provider receives reimbursement directly from the payer.






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






4. Theperson eligible to receive healthcare benefits.






5. Organization that accredits clearinghouses






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






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






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






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






10. The insurance claim form used to report professional services






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






12. Contract out






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






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






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






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






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






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






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






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






21. 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.






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






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






24. 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.






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






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






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






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






29. Form used to report institutional - facility services.






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






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






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






33. Computer to computer data exchange between payer and provider






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






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






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






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






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






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






40. 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;






41. 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.






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






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






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






45. Person responsible for paying healthcare fees






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






47. 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






48. 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;






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






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