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Test your basic knowledge |
Health Insurance
Start Test
Study First
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. Abstract of all recent claims filed on each patient.
CMS-1500
Encounter form
Participating provider
Common data file
2. Also called manual daily accounts receivable journal; cronological summary of all transactions posted to individual patient legers/accounts on a specific day.
Beneficiary
Accounts receivable
CMS-1500
Day sheet
3. Also called a day sheet - a chronological summary of all transactions posted to individual patient ledgers/accounts on a specific day.
Encounter form
Manual daily accounts receivable journal
Fair Credit Billing Act
Claims attachment
4. A computerized permanent record of all financial transactions between the patient and the pratice - also called patient ledger.
Nonparticipating provider
Claims submission
Patient account record
Electronic funds transfer
5. Person responsible for paying healthcare fees
Covered entity
Guarantor
Downcoding
Patient account record
6. Organization that accredits clearinghouses
Electronic Healthcare Network Accreditation Commission EHNAC
Covered entity
Beneficiary
Provider Remittance Notice
7. Advances through various aging periods( 30 -60 -90 -120) with practices typically focusing internal recovery efforts on older delinquent accounts.
Bad debt
Delinquent claim cycle
Noncovered benefit
Outsourcing
8. The insurance claim form used to report professional services
Patient account record
CMS-1500
Accounts receivable management
Past-due account
9. Submitting multiple CPT codes when one code could of been submitted.
Unbundling
Closed claim
Primary insurance
Claims processing
10. Establishes the rights. liabilites - and rsponsibilities of participants in electronic funds transfer systems.
Two-party check
Electronic funds transfer ACT
Assignment of benefits
Common data file
11. Term used for the encounter form in the physicians's office.
Unbundling
Provider Remittance Notice
Superbill
Chargemaster
12. 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
Fair debt collection practicies Act
Unauthorized service
Fair credit reporting Act
CMS-1500
13. Does not contract with the insurance plan; patient who elects to recieve care from nonPARS will incur higher out-of-pocket expenses.
Claims attachment
Nonparticipating provider
Electronic claim processing
Litigation
14. 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
Consumer Credit Protection Act of 1968
Electronic Healthcare Network Accreditation Commission EHNAC
Allowed charges
Fair Credit and Charge Card Disclosure ACT
15. Sorting claims upon submission to collect and verify information about a patient and provider.
Electronic media claim
Manual daily accounts receivable journal
Claims processing
Pre-existing condition
16. 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.
CMS-1500
Covered entity
Electronic funds transfer
Electronic remittance advi
17. Uses a variable-length file format to process transactions for institutional - professional - dental - and drug claims.
Unbundling
ANSI ASC X12 standards
Coordination of benefits (COB)
Patient account record
18. A computerized permanent record of all financial transactions between the patient and the practice;also called patient account record.
Patient ledger
Superbill
Unauthorized service
Chargemaster
19. Associated with how an insurance plan is billed-the insurance plan responsible for paying healthcare insurance claims first is considered primary.
Nonparticipating provider
Provider Remittance Notice
Delinquent account
Primary insurance
20. Remittance advice submitted by Medicare to providers that includes payment information about a claim.
Participating provider
Provider Remittance Notice
Two-party check
Unbundling
21. Determines coverage by primary and secondary policies when each parent subscribes to a different health insurance plan.
Fair Credit Billing Act
Encounter form
Birthday rule
Two-party check
22. 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.
Electronic remittance advi
Equal Credit Opportunity ACT
Litigation
Assignment of benefits
23. One that has not been paid within a certain time frame; also called delinquent account
Past-due account
Accept assignment
Electronic Healthcare Network Accreditation Commission EHNAC
Bad debt
24. The amount owed to a business for services or goods provided
Electronic claim processing
Accounts receivable
Encounter form
Deliquent claim
25. Financial record source document used by providers and other personnel to record treated diagnoses and services rendered to the patient during the current encounter.
Coordination of benefits (COB)
Pre-existing condition
Encounter form
Electronic Healthcare Network Accreditation Commission EHNAC
26. 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;
Patient ledger
Fair Credit and Charge Card Disclosure ACT
Unassigned claim
Two-party check
27. A correctly completed standardized claim
Noncovered benefit
Encounter form
Clean claim
Unbundling
28. Is a past due account; one that has not been paid within a certain time frame.
Delinquent account
Value-added network (VAN)
Guarantor
Electronic flat file format
29. The maximum amount a payer will reimburse for each procedure or service - according to the patient's policy.
Outsourcing
CMS-1500
Chargemaster
Allowed charges
30. Accounts receivable that cannot be collected by the provider or a collect agency.
Electronic remittance advi
Bad debt
Fair debt collection practicies Act
Assignment of benefits
31. Health plans - healthcare clearinghouses - government health plans - and any health providers that choose to submit or receive transactions electronically.
Accept assignment
Chargemaster
Covered entity
Fair Credit and Charge Card Disclosure ACT
32. 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.
Delinquent claim cycle
Unassigned claim
Common data file
Out-of-pocket payment
33. Services that are provided to a patient without proper authorization or that are not covered by a current authorization.
Pre-existing condition
Patient account record
Unauthorized service
Birthday rule
34. Theperson eligible to receive healthcare benefits.
Beneficiary
Downcoding
Provider Remittance Notice
ANSI ASC X12 standards
35. Assists providers in the collection of appropriate reimbursement for services rendered; includes functions such as insurance verfication/eligibility and preauthorization of services
Accounts receivable management
Delinquent claim cycle
Primary insurance
Assignment of benefits
36. A routing slip - charge slip - encounter form - or suberbill from which the insurance claim was generated.
Bad debt
Claims attachment
Electronic remittance advi
Source document
37. Computer to computer data exchange between payer and provider
Claims submission
Electronic Healthcare Network Accreditation Commission EHNAC
Fair credit reporting Act
Electronic data interchange EDI
38. The provider receives reimbursement directly from the payer.
Open claim
Assignment of benefits
Patient ledger
Claims submission
39. Medical report substantiating a medical condition
Claims attachment
Birthday rule
Electronic Healthcare Network Accreditation Commission EHNAC
Unbundling
40. The percentage the patient pays for covered services after the deductible has been met and the copayment has been paid.
Source document
Primary insurance
Coinsurance
Electronic funds transfer ACT
41. Sending data in a standardized machine readable format to an insurance company via disk - telephone or cable.
Chargemaster
Electronic claim processing
Claims submission
Deliquent claim
42. 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.
Provider Remittance Notice
Deliquent claim
Noncovered benefit
Accept assignment
43. Amount for which the patient is financially responsible before an insurance company provides coverage.
Electronic funds transfer ACT
Encounter form
Deductible
Fair debt collection practicies Act
44. 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
CMS-1500
Electronic flat file format
Out-of-pocket payment
Accounts receivable aging report
45. Claims for which all processing - including appeals - has been completed.
Day sheet
Electronic data interchange EDI
Closed claim
UB-04
46. Series of fixed length records submitted to payers to bill for health care services.
Beneficiary
Coinsurance
Primary insurance
Electronic flat file format
47. Assigning lower-level codes then documented in the record.
Clearinghouse
UB-04
Assignment of benefits
Downcoding
48. The term hospitals use to describe the encounter form.
Chargemaster
Deductible
Out-of-pocket payment
Unauthorized service
49. 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.
Claims processing
Claims attachment
Coordination of benefits (COB)
Fair credit reporting Act
50. Shows the status (by date) of outstanding claims from each payer - as well as payments due from patients
Assignment of benefits
Bad debt
Patient ledger
Accounts receivable aging report