Health Insurance
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Avg score: 44% • Most missed: “Determines coverage by primary and secondary policies when each parent subscribe…”
Health Insurance
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1. Submitted to the payer - but processing is not complete

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

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

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

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

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

7. Person responsible for paying healthcare fees

8. The insurance claim form used to report professional services

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

10. 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.

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

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

13. Contract out

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

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

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

17. Medical report substantiating a medical condition

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

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

20. A correctly completed standardized claim

21. 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

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

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

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

25. Theperson eligible to receive healthcare benefits.

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