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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25 Questions

1. Organization that accredits clearinghouses

2. The insurance claim form used to report professional services

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

4. Contract out

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

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

7. Computer to computer data exchange between payer and provider

8. 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.

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

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

11. 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

12. A correctly completed standardized claim

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

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

15. 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.

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

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

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

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

20. Theperson eligible to receive healthcare benefits.

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

22. Person responsible for paying healthcare fees

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

24. 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

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

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