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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. 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.






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






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






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






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






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






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






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






9. 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






10. Computer to computer data exchange between payer and provider






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






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






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. 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






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






16. 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;






17. A correctly completed standardized claim






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






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






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






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






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






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






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






25. 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






26. Theperson eligible to receive healthcare benefits.






27. Form used to report institutional - facility services.






28. 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






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






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






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






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






33. The insurance claim form used to report professional services






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






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






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






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






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






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






40. 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.






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






42. Organization that accredits clearinghouses






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






44. Medical report substantiating a medical condition






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






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






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






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






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






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







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