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10 Cards in this Set
- Front
- Back
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What is email?
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Email is sending messages over the internet.
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What is formatting?
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Magnetically creating tracks in a disk so that information can be stored on that disk.
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Define the following terms and abbreviations.
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Beneficiary:
Deductible: The portion of the bill that a subscriber must pay before insurance coverage is effective. Referral: A term used in managed care to refer a patient from the PCP to a specialist. Claim: Indemnity Plans: Pay for all or shared of the cost of covered services regardless of which physicians, hospital, or other licensed healthcare provider is used. Rider: Co-Insurance: A percentage of of the total cost (on an 80/20 policy, the subscriber pays 20% of the costs). Limitation: Subscriber: Copayment: A continuation the subscriber must make to cover some portion of the bill. Premium: Paid monthly or annually to keep the policy in force. |
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Describe prepaid hospital insurance and fringe benefits.
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Prepaid hospital insurance is the first prepaid hospital insurance was created in the 1930's by a group of school teachers in Texas. This was the origin of Blue Cross Hospital Care.
Fringe Benefits: Became a significant element of bargaining for workers. Group health insurance became a large part of the fringe benefit package.A fringe benefit is a benfit that does not affect the base wage. |
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What is coordination of benefits (COB) and how does COB work?
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Limits the benefits to 100% of the cost. Prevents duplicate payments for the same service. COB follows the rules of the plan that is primary payer.
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Describe the following types of insurance benefits.
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Basic Medical: Pays all or part of the physicians fees for nonsurgical services, including hospital, home, and office visits.
Hospitalization: Pays the cost of all or part of the insured persons hospital room and board and special hospital services. Major Medical: Provides protection against especially heavy medical bills resulting from prolonged illnesses. Special Class: Provides limited health coverage for those who cannot qualify for health insurance because of existing health problems. |
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Describe the following types of government insurance plans.
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CHAMPVA: Provides medical care for dependents of veterans suffering service-connected disabilities, and for the surviving dependents of veterans who have died as a result of service-connected disabilities.
Tricare/CHAMPUS: Provides medical coverage for for dependents of active military personnel, military retirees, and military personnel who have died in active duty. Disability: Loss of wage coverage for persons who have non job related injuries or illnesses. There is a waiting period of 7 days for benifits unless the individual is hospitalized in which case benefits begin immediately. Medicaid: Provides basic funding for healthcare of the medically indigent, persons receiving SSI benefits, low-income elderly on Medicare, recipients of AFDC, and persons receiving 20% insurance. Workers' Compensation: Protects wage earners against the loss of wages and the cost of medical care resulting from occuptional accident or disease. There are time limits for reporting workers' compensation cases. Medicare: Developed in 1966 as a national health insurance for the elderly. Medical coverage for persons 65 years of age and older, the permanently disabled or blind, and persons who are receiving dialysis or who have had a kidney transplant. |
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What is an authorization?
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A term used by manged care for an approbed referral. The patient must present the authorization to the specialist's office on the day the services will be provided.
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What is a referral? List the 3 types of referrals and describe each.
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A referral is a term used in managed care to refer a patient from the PCP to a specialist.
1.) Regular: Takes 3 to 10 working days. Used for patients who have not responded to treatment by the PCP. 2.) Urgent: Takes 24 hours. Used when an urgent manner occurs that is not life threatening. 3.) STAT: Can be approved by telephone immediately. Used in emergency situations that are life threatening. |
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What are three ways of filing and describe each.
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1.) A symbol on the outside indicating the status of the record.
2.) Safeguards to prevent misfiling. 3.) A filing system that allows quick, accurate retrieval and refilling. |
