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






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






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






4. 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.






5. 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.






6. Computer to computer data exchange between payer and provider






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






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






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






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






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






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






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






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






15. 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.






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






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






18. The amount owed to a business for services or goods provided






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






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






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






22. 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.






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






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






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






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






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. Submitted to the payer - but processing is not complete






31. Theperson eligible to receive healthcare benefits.






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






33. Organization that accredits clearinghouses






34. 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.






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






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






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






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






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






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






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






42. 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






43. The provider receives reimbursement directly from the payer.






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






45. The insurance claim form used to report professional services






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






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






48. 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;






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






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