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. 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.






2. Organization that accredits clearinghouses






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






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






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






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






7. Contract out






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






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






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






11. The provider receives reimbursement directly from the payer.






12. Theperson eligible to receive healthcare benefits.






13. 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






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






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






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






17. 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.






18. 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






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






20. 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;






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






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






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






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






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






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






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






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






29. Form used to report institutional - facility services.






30. 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.






31. Person responsible for paying healthcare fees






32. 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






33. 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;






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






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






36. Medical report substantiating a medical condition






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






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






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






40. Computer to computer data exchange between payer and provider






41. A correctly completed standardized claim






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






43. 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






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






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






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






47. The insurance claim form used to report professional services






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






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






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