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35 Cards in this Set
- Front
- Back
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Of the federal program is providing healthcare the largest which provides health insurance for citizens at age 65 and older |
Medicare |
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What is the authorization called that direction insurance carrier to pay the medical provider or medical practice directly |
Assignment of benefits |
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Patient to belong to a managed care health plan such as an HMO are responsible for a small pre-visit fee collected at the time of visit |
Copayment |
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The fixed dollar amount a subscriber must pay or meet each year the insurer begins to cover expenses is the |
Deductible |
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The person whose name the insurance is carried under is called the |
Subscriber |
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When the insurance person paid for annual cost for health insurance I just called |
Premium |
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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 |
Denied because the treatment was not medically necessary based on the diagnosis |
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Which of the following is what the patient owes after the insurance company has paid |
Patient liability |
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And insurance claims department compares the fee the doctor charges with the benefits provided by the patient's health plan this is called |
Review of allowable benefits |
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Which insurance covers a patient who had been hospitalized up to 90 days for each benefit period |
Medicare part |
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Which of the following is a carrot stick of Medicaid |
It is a health cost assistance program |
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Which of the following is a carrot stick of Medicaid |
It is a health cost assistance program |
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Which of the following statements applies to physician agrees to except Medicaid patients |
The physician can bill the patient for services that Medicaid does not cover |
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One advantage of submitting claims electronically is |
Electronic submissions or cost efficient |
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One advantage of submitting claims electronically is |
Electronic submissions or cost efficient |
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Which statement is true regarding health maintenance organization |
Doctors with HMO contracts are often paid a capitated rate |
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Which of the following is correct regarding electronic claim submission |
Clams or repaired for transmission after all require data elements of been entered |
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Insurance carriers perform a review for medical______ on each claim to determine whether the treatment is needed for the diagnoses listed |
Necessity |
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A _____ healthcare claim is one of the air free and digit excepted for processing by the pair |
Clean claim |
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Which Medicare plan covers prescription medications |
Part d |
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The payment system used by____ is called the resource-based relative value scale ( RBRVS) |
Medicare |
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Insurers include either an explanation of payment or… Advice along with payment to practice or to the patient depending on whether an assignment of benefits was signed |
Remittance advice |
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Insurers include either an explanation of payment or… Advice along with payment to practice or to the patient depending on whether an assignment of benefits was signed |
Remittance advice |
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A procedure as a medical procedure that is not required to sustain life and that is planned in advance to be done at the convenience of the surgeon and the patient |
Elective |
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Feeling the patient for the difference between a higher her usual fee in the lower allowed charge is called |
Balance billing |
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The provider should have the patient sign… Event of that statement under which the provider agrees to repair a healthcare a claim for the patient and to receive payments directly from payer |
Assignment |
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A fix for your payment is made under contract to have medical provider for each claim number and what payment method |
Capitation |
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A small fee collected at the time of services called |
Copay |
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The fixed amount of us we paid a policyholder each year before third-party payer begins to cover medical expenses |
Deductible |
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Payments made by health plan for medical services provided to the patient or known as |
Benefits |
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And annual payment made to an insurance company for patient to keep insurance policy in effect |
Premium |
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A fixed percentage payable by patient after the deductible is met |
Coinsurance |
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Request for approval for payment from a third-party payer prior to a procedure |
Preauthorization |
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Request for approval for payment from a third-party payer prior to a procedure |
Preauthorization |
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The process of deciding the amount of money that will be paid by third-party payer for procedure is |
Pre-determination |
