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. The insurance claim form used to report professional services






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






3. A correctly completed standardized claim






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






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






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






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






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






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






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






11. Person responsible for paying healthcare fees






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






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






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






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






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






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






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






19. 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






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






21. 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.






22. Theperson eligible to receive healthcare benefits.






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






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






25. 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.






26. 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






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






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






29. Computer to computer data exchange between payer and provider






30. Form used to report institutional - facility services.






31. 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.






32. 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;






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






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






35. 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.






36. Contract out






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






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






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






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






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






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






43. 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;






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






45. 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.






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






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






48. Organization that accredits clearinghouses






49. 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






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