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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. Accounts receivable that cannot be collected by the provider or a collect agency.
Litigation
ANSI ASC X12 standards
Bad debt
Downcoding
2. A computerized permanent record of all financial transactions between the patient and the practice;also called patient account record.
Two-party check
Electronic data interchange EDI
Accounts receivable aging report
Patient ledger
3. Establishes the rights. liabilites - and rsponsibilities of participants in electronic funds transfer systems.
Outsourcing
Chargemaster
Electronic funds transfer ACT
Deductible
4. Abstract of all recent claims filed on each patient.
Clean claim
Claims attachment
Common data file
Provider Remittance Notice
5. Shows the status (by date) of outstanding claims from each payer - as well as payments due from patients
Open claim
Claims adjudication
Nonparticipating provider
Accounts receivable aging report
6. Submitted to the payer - but processing is not complete
Unassigned claim
Downcoding
Open claim
Beneficiary
7. Assists providers in the collection of appropriate reimbursement for services rendered; includes functions such as insurance verfication/eligibility and preauthorization of services
Accept assignment
Unbundling
Allowed charges
Accounts receivable management
8. Computer to computer data exchange between payer and provider
Electronic data interchange EDI
Primary insurance
ANSI ASC X12 standards
Accounts receivable management
9. Legal action to recover a debt; usually a last resort for a medical practice.
Electronic funds transfer ACT
Encounter form
Litigation
Fair credit reporting Act
10. The insurance claim form used to report professional services
CMS-1500
Beneficiary
Clean claim
Equal Credit Opportunity ACT
11. Sending data in a standardized machine readable format to an insurance company via disk - telephone or cable.
Electronic claim processing
Noncovered benefit
Chargemaster
Consumer Credit Protection Act of 1968
12. 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;
Outsourcing
Electronic media claim
Nonparticipating provider
Fair Credit Billing Act
13. The amount owed to a business for services or goods provided
Accept assignment
Nonparticipating provider
Accounts receivable
Closed claim
14. Specifies what a collection source may or may not do when pursuing payment on past due accounts.
Primary insurance
Accounts receivable aging report
Fair debt collection practicies Act
Electronic data interchange EDI
15. Contracts with a helath insurance plan and accepts whatever the plan pays for procedures or services performed.
Open claim
Participating provider
Manual daily accounts receivable journal
ANSI ASC X12 standards
16. A computerized permanent record of all financial transactions between the patient and the pratice - also called patient ledger.
Patient account record
Guarantor
Claims attachment
Fair Credit and Charge Card Disclosure ACT
17. The percentage the patient pays for covered services after the deductible has been met and the copayment has been paid.
Patient account record
Chargemaster
UB-04
Coinsurance
18. Contract out
Outsourcing
Patient account record
Nonparticipating provider
Fair debt collection practicies Act
19. Uses a variable-length file format to process transactions for institutional - professional - dental - and drug claims.
Electronic flat file format
Bad debt
ANSI ASC X12 standards
Claims adjudication
20. The term hospitals use to describe the encounter form.
Primary insurance
Chargemaster
Electronic remittance advi
Day sheet
21. 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.
Noncovered benefit
Accounts receivable
Deductible
Consumer Credit Protection Act of 1968
22. The transmission of claims data (electronical or manually) to payers or clearinghouses for processing.
Outsourcing
Claims submission
Source document
Accounts receivable aging report
23. Also called a day sheet - a chronological summary of all transactions posted to individual patient ledgers/accounts on a specific day.
Electronic remittance advi
Manual daily accounts receivable journal
Open claim
Accounts receivable aging report
24. Organization that accredits clearinghouses
Electronic remittance advi
Two-party check
Manual daily accounts receivable journal
Electronic Healthcare Network Accreditation Commission EHNAC
25. Remittance advice submitted by Medicare to providers that includes payment information about a claim.
Electronic claim processing
Electronic remittance advi
Provider Remittance Notice
Closed claim
26. 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
Fair Credit Billing Act
Claims adjudication
Manual daily accounts receivable journal
Nonparticipating provider
27. One that has not been paid within a certain time frame; also called delinquent account
Chargemaster
Value-added network (VAN)
Primary insurance
Past-due account
28. Series of fixed length records submitted to payers to bill for health care services.
Nonparticipating provider
Unauthorized service
Patient ledger
Electronic flat file format
29. Claims for which all processing - including appeals - has been completed.
Bad debt
Fair Credit Billing Act
Closed claim
Electronic claim processing
30. 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.
Equal Credit Opportunity ACT
Noncovered benefit
Electronic claim processing
CMS-1500
31. Form used to report institutional - facility services.
Electronic Healthcare Network Accreditation Commission EHNAC
Outsourcing
UB-04
Manual daily accounts receivable journal
32. 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.
Consumer Credit Protection Act of 1968
Downcoding
Past-due account
Coordination of benefits (COB)
33. 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;
Open claim
Fair Credit and Charge Card Disclosure ACT
Electronic flat file format
ANSI ASC X12 standards
34. When the provider agrees to accept what the insurance company allows or aproves as payment in full for the claim
Accept assignment
Coinsurance
Coordination of benefits (COB)
Electronic data interchange EDI
35. A check made out to the patient and the provider.
Day sheet
Clearinghouse
Two-party check
Electronic Healthcare Network Accreditation Commission EHNAC
36. 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
Guarantor
Consumer Credit Protection Act of 1968
Fair Credit Billing Act
Common data file
37. Series of fixed length records submitted to payers to bill for health care services.
Fair Credit Billing Act
Two-party check
Past-due account
Electronic media claim
38. Any medical condition that was diagnosed and or treated within a specified period of time immediately preceding the enrollee's effective date of coverage.
Participating provider
Fair Credit and Charge Card Disclosure ACT
Electronic funds transfer ACT
Pre-existing condition
39. The maximum amount a payer will reimburse for each procedure or service - according to the patient's policy.
Birthday rule
Allowed charges
Unassigned claim
Electronic data interchange EDI
40. 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
Delinquent account
Accounts receivable
Fair credit reporting Act
Closed claim
41. Associated with how an insurance plan is billed-the insurance plan responsible for paying healthcare insurance claims first is considered primary.
Beneficiary
Participating provider
Primary insurance
Pre-existing condition
42. Does not contract with the insurance plan; patient who elects to recieve care from nonPARS will incur higher out-of-pocket expenses.
Encounter form
Nonparticipating provider
Unauthorized service
Noncovered benefit
43. Sorting claims upon submission to collect and verify information about a patient and provider.
Day sheet
Common data file
Claims processing
Accept assignment
44. Also called manual daily accounts receivable journal; cronological summary of all transactions posted to individual patient legers/accounts on a specific day.
Chargemaster
Day sheet
Common data file
Electronic remittance advi
45. System by which payers deposit funds to the providers account electronically.
Electronic funds transfer
Electronic flat file format
Beneficiary
Superbill
46. Term used for the encounter form in the physicians's office.
Claims processing
Day sheet
Superbill
Patient ledger
47. 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.
Past-due account
Unassigned claim
Clearinghouse
Participating provider
48. 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
Assignment of benefits
Day sheet
Accounts receivable
Value-added network (VAN)
49. Determines coverage by primary and secondary policies when each parent subscribes to a different health insurance plan.
ANSI ASC X12 standards
Birthday rule
Unauthorized service
Fair Credit and Charge Card Disclosure ACT
50. 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.
Common data file
ANSI ASC X12 standards
Assignment of benefits
Electronic remittance advi