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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. Theperson eligible to receive healthcare benefits.






2. 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.






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






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






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






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






7. 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;






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






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






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






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






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






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






14. 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.






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






16. The provider receives reimbursement directly from the payer.






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






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






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






20. Computer to computer data exchange between payer and provider






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






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






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. The insurance claim form used to report professional services






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






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






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






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






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






30. 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.






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






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






33. 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.






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






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






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






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






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






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






40. 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






41. Form used to report institutional - facility services.






42. 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






43. Medical report substantiating a medical condition






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. 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






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






48. Organization that accredits clearinghouses






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






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






Can you answer 50 questions in 15 minutes?



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