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






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






3. 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.






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






5. 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.






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






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






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






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






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






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






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






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






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






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






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






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






18. Contract out






19. Computer to computer data exchange between payer and provider






20. 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






21. Shows the status (by date) of outstanding claims from each payer - as well as payments due from patients






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






23. 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;






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






25. Medical report substantiating a medical condition






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. 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






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






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






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






32. A correctly completed standardized claim






33. 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






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






35. 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;






36. Person responsible for paying healthcare fees






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






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






39. 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






40. Theperson eligible to receive healthcare benefits.






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






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






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






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






45. 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.






46. The insurance claim form used to report professional services






47. 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.






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. Organization that accredits clearinghouses






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