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






2. Computer to computer data exchange between payer and provider






3. 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;






4. 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;






5. 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.






6. 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






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






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






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






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






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






12. Contract out






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






14. 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.






15. 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






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. 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






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






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






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






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






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






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






24. The insurance claim form used to report professional services






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






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






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






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






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






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






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






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






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






34. 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.






35. 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






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






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






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






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






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






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






42. Medical report substantiating a medical condition






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






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






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






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






47. 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






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






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






50. 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.