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






2. 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.






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






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






5. 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.






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






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






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






9. A correctly completed standardized claim






10. Computer to computer data exchange between payer and provider






11. 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.






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






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






14. Form used to report institutional - facility services.






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






16. The insurance claim form used to report professional services






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






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






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






20. 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.






21. The provider receives reimbursement directly from the payer.






22. 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






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






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






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






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






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






28. Theperson eligible to receive healthcare benefits.






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






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






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






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






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






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






35. Person responsible for paying healthcare fees






36. 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






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






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






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






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






41. 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;






42. 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






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






44. 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.






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






46. 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;






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






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






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






50. 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