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. 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.






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






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






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






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






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






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






8. Medical report substantiating a medical condition






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






10. 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.






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






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






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






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






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






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






17. The insurance claim form used to report professional services






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






19. A correctly completed standardized claim






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






21. 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;






22. 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;






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






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






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






26. 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






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






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






29. 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.






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






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






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






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






34. Computer to computer data exchange between payer and provider






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






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






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






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






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






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






41. 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






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






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






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






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






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






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






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






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.






50. The provider receives reimbursement directly from the payer.