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






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






3. Person responsible for paying healthcare fees






4. A correctly completed standardized claim






5. 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;






6. 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.






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






8. 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






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






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






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






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






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






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






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






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






17. Medical report substantiating a medical condition






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






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






20. 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.






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






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






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






24. Form used to report institutional - facility services.






25. 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






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






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






28. Theperson eligible to receive healthcare benefits.






29. The insurance claim form used to report professional services






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






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






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






33. Contract out






34. The provider receives reimbursement directly from the payer.






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






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






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






38. 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.






39. 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






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






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






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






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






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






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






46. Computer to computer data exchange between payer and provider






47. 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;






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






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






50. Organization that accredits clearinghouses