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






2. Contract out






3. 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;






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






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






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






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






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






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






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






11. Computer to computer data exchange between payer and provider






12. 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.






13. 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






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






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






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






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






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






19. 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;






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






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






22. Medical report substantiating a medical condition






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






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






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






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






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






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






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






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






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






32. 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.






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






34. A correctly completed standardized claim






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






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






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






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






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






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






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. The provider receives reimbursement directly from the payer.






43. Person responsible for paying healthcare fees






44. Form used to report institutional - facility services.






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






46. 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.






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






48. Organization that accredits clearinghouses






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






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