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. 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.

2. Organization that accredits clearinghouses

3. Computer to computer data exchange between payer and provider

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

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

6. 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

7. 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.

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

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

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

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

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

13. 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

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

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

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

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

18. 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;

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

20. 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

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

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

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

24. 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;

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

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