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






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






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






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






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






6. Theperson eligible to receive healthcare benefits.






7. A correctly completed standardized claim






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






9. Form used to report institutional - facility services.






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






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






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






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






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






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






16. 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.






17. 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.






18. 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.






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






20. 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;






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






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






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






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






25. 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.






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






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






28. Contract out






29. 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;






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






31. The insurance claim form used to report professional services






32. 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






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






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






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






36. Computer to computer data exchange between payer and provider






37. Person responsible for paying healthcare fees






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






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






40. 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






41. The provider receives reimbursement directly from the payer.






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






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






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






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






46. 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






47. 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






48. 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.






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






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