Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
43 Cards in this Set
- Front
- Back
Of the federal programs providing healthcare, the largest is what, which provides health insurance for citizens age 65 and older? |
Medicare |
|
What is the authorization called that directs and insurance carrier to pay the medical provider or the medical practice directly? |
Assignment of benefits |
|
Patients who belong to a managed-care health plan such as an HMO are responsible for a small per visit fee collected at the time of the visit this fee is commonly called a what? |
Copayment |
|
The fixed dollar amount a subscriber must pay or meet each year before the insurer begins to cover expenses is the what? |
Deductible |
|
The person whose name the insurance is carried under is called the what? |
Subscriber |
|
When the insured person pays an annual cost for healthcare insurance it is called a what? |
Premium |
|
The most likely outcome of an insurance claim submitted with a diagnosis code of a sore throat and a treatment code indicating a cast for a broken leg would be what? |
Denied because the treatment was not medically necessary based on the diagnosis |
|
Which of the following is what the patient owes after the insurance company has paid? |
Patient liability |
|
And insurance claims department compares the fee the doctor charges with the benefits provided by the patient's health plan this is called the what? |
Review for allowable benefits |
|
Which insurance covers a patient who has been hospitalized up to 90 days for each benefit period? |
Medicare part A |
|
Which of the following is a characteristic of Medicaid? |
It is a health cost assistance program |
|
Which of the following statement applies to a physician who agrees to except Medicaid patients? |
The physician can bill a patient for services that Medicaid does not cover |
|
One advantage of submitting claims electronically is what? |
Electronic submissions are cost-efficient |
|
Which statement is true regarding health maintenance organization's? |
Physicians with HMO contracts are often paid a capitated rate |
|
A husband and wife are both employee and have work sponsor insurance plans that cover each other and their three children which insurance plan is the primary payer? |
The insurance plan of the person whose birthday comes first in the calendar year |
|
Which of the following is correct regarding electronic claims submissions? |
Claims are prepared for transmission after all require data elements have been entered |
|
Which of the following is correct regarding electronic claims submissions? |
Claims are prepared for transmission after all require data elements have been entered |
|
Which Medicare plan covers prescription medications? |
Part D |
|
What is the birthday rule? |
The insurance policy of the policyholder whose birthday comes first in the calendar year is the primary payer for all dependent |
|
What is the birthday rule? |
The insurance policy of the policyholder whose birthday comes first in the calendar year is the primary payer for all dependent |
|
The request for approval for payment from a third-party payer prior to a procedure is the what? |
Pre-authorization |
|
What is the birthday rule? |
The insurance policy of the policyholder whose birthday comes first in the calendar year is the primary payer for all dependent |
|
The request for approval for payment from a third-party payer prior to a procedure is the what? |
Pre-authorization |
|
The process of deciding the amount of money that will be paid by a third-party payer for a procedure is what? |
Predetermination |
|
Insurance carriers perform a review for medical_____on each claim to determine whether the treatment is needed for the diagnoses listed |
Necessity |
|
Insurance carriers perform a review for medical_____on each claim to determine whether the treatment is needed for the diagnoses listed |
Necessity |
|
An _____healthcare claim is one that is error-free and is excepted for processing by the payer |
Clean |
|
The payment system used by___is called the resource base relative value scale (RBRVS) |
Medicare |
|
Insurers include either an explanation of payment or a___device along with payment to the practice or to the patient depending on whether an assignment of benefits was signed |
Remittance |
|
Insurers include either an explanation of payment or a___device along with payment to the practice or to the patient depending on whether an assignment of benefits was signed |
Remittance |
|
A___procedure is a medical procedure that is not required to sustain life and that is planned in advance to be done at the convenience of The physician or surgeon and the patient |
Elective |
|
Because Medicare pays 80% of approved charges and the patient is responsible for the remaining 20% individuals enrolled in the original Medicare part B plan often buy additional insurance called a___plan |
Medigap |
|
Billing the patient for the difference between a higher usual fee and a lower allowed charge is called__billing |
Balance |
|
The provider should have the patient sign a___of benefits statement under which the provider agrees to prepare healthcare claims for the patient and to receive payments directly from the payer |
Assignment |
|
A fixed pre-payment is made under contract to a medical provider for each plan member and the___payment method |
Capitated |
|
The___is a fixed amount that must be paid by the policyholder each year before a third-party payer begins to cover medical expenses |
Deductible |
|
Payments made by a health plan for medical services provided to the patient or known as___ |
Benefits |
|
Payments made by a health plan for medical services provided to the patient or known as___ |
Benefits |
|
The___is the annual payment made to an insurance company by the patient to keep the insurance policy in effect |
Premium |
|
The___is a fixed percentage payable by the patient after that the deductible is met |
Coinsurance |
|
The___is a fixed percentage payable by the patient after that the deductible is met |
Coinsurance |
|
Expenses that are not covered by insurance plan are called___ |
Exclusions |
|
A small fee that is collected at the time of service is called a___ |
Co-pay |