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. Submitted to the payer - but processing is not complete






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






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






4. Term used for the encounter form in the physicians's office.






5. 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






6. Form used to report institutional - facility services.






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






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






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






10. Person responsible for paying healthcare fees






11. 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.






12. 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.






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






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






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






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






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






18. Contract out






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






20. 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;






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






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






23. 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






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






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






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






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






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






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






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






31. The provider receives reimbursement directly from the payer.






32. The insurance claim form used to report professional services






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






34. 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






35. A correctly completed standardized claim






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






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






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






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






40. 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






41. 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.






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






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






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






45. 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.






46. 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.






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






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






49. Theperson eligible to receive healthcare benefits.






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