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






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






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






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






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






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






7. 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.






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






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






10. 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






11. Contract out






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






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






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






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






16. 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






17. A correctly completed standardized claim






18. The provider receives reimbursement directly from the payer.






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






20. Organization that accredits clearinghouses






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






23. 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.






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






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






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






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






28. Medical report substantiating a medical condition






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






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






31. 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;






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






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






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






35. 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






36. Computer to computer data exchange between payer and provider






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






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






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






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






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






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






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






44. 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






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






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






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






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






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






50. Form used to report institutional - facility services.







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