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. Contract out






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






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






4. The provider receives reimbursement directly from the payer.






5. 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






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






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






8. Organization that accredits clearinghouses






9. Computer to computer data exchange between payer and provider






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






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






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






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






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






15. 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.






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






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






18. A correctly completed standardized claim






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






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






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






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






23. Theperson eligible to receive healthcare benefits.






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






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






26. The insurance claim form used to report professional services






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






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






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






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






31. 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.






32. Medical report substantiating a medical condition






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






34. 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;






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






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






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






38. 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






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






40. 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






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






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






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






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






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






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






47. 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.






48. Form used to report institutional - facility services.






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






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