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






2. Person responsible for paying healthcare fees






3. Form used to report institutional - facility services.






4. Contract out






5. A correctly completed standardized claim






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






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






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






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






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






11. The provider receives reimbursement directly from the payer.






12. 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.






13. 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.






14. Computer to computer data exchange between payer and provider






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






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






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






18. Theperson eligible to receive healthcare benefits.






19. 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;






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






21. Organization that accredits clearinghouses






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






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






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






25. 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






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






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






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






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






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






31. 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






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






33. 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.






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






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






36. 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.






37. 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






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






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






40. 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






41. 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






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






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






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






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






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






47. The insurance claim form used to report professional services






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






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






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