Health Insurance

Front 1

Clerk who enters patients demographical information into a computer nd obtains signed statements from patients to protect hospitals interests

Back 1

Admitting Clerk

Front 2

Specializes in maintaining patient accounting records, filing health insurance claims, working insurance carriers to receive imbursement on insurance claims filed, appealing denied claims

Back 2

Centralized Billing Office

Front 3

Training received in a particular field that acknowledges a medical office specialists expertise

Back 3

Certification

Front 4

A facility that centralizes the process of billing patients and carriers for treatment received at an inpatient facility

Back 4

Patient Account Services

Front 5

Coordinates services related to inpatient medical coding, documentation, abstracting data collection and reimbursement

Back 5

Registered Health Information Technician

Front 6

a business that contracts with physicians to handle their claims and/or accounts receivable is referred to as a

Back 6

Physicians billing office

Front 7

What job description requires excellent data entry skills, math skills, and a good working knowledge of insurance contracts

Back 7

Payment poster

Front 8

a meical collector will contact most patients by

Back 8

telephone

Front 9

a refund specialist position requires

Back 9

researching and analytical skills

Front 10

What abbreviation stands for a coder who specializes in hospital coding?

Back 10

CPC-H

Front 11

A large Physician group practice consists of

Back 11

10 plus physicians and physcians who practice in different specialities

Front 12

a small physician group practice consists of

Back 12

three through nine physicians ; physicians usually practicing the same specialty

Front 13

Which law establishes guidelines to ensure patient privacy compliance and healh plan portability

Back 13

HIPPA

Front 14

A person who is covered under and insurance policy is known as the

Back 14

policyholder

Front 15

_______ and ______ are other job titles for a medical biller

Back 15

Billing specialist Patient Account Representative

Front 16

a medical office assistant may be also referred to as a medical

Back 16

receptionist or secretary

Front 17

Professional membership is an excellent addition to your

Back 17

resume

Front 18

The payment Poster generally reads the ____ from insurance carriers and posts the payments or contractual adjustments to the appropriate patient account

Back 18

EOB

Front 19

The knowledge of medical ___ and ___ is imperative to perform well in all medical administrative positions

Back 19

Billing Coding

Front 20

The Amount employees had to pay out of their pockets before insurance began paying is called the _______

Back 20

Deductible

Front 21

A physicia who coordinaes a patient's care and refers patients specialists is a

Back 21

Primary Care Physcian

Front 22

A ____ contracts with more than one community based multispecialty group to provide wider geographical coverage

Back 22

HMO

Front 23

When a provider agrees to receive payment directly from the patients insurance carrier it is accepting

Back 23

Assignment of Benefits

Front 24

A _____ medical condition is a diagnosis that the insured has previously been treated fo and that may not be covered by a traditional insurance plan

Back 24

Preexisting

Front 25

The lists of medical services covered uder the insured policy is called the

Back 25

Schedule of benefits

Front 26

The charge a covered person is required to pay at the time covered services are provided is a

Back 26

copay

Front 27

A managed care contract is a legal between a healthcare ___ and a _____

Back 27

HMO, NEtWoRK

Front 28

When an MCO examines a physicians background for evidence of fraud or criminal activity the process is called

Back 28

Credentaling

Front 29

Managed care is a system that controls the ___ and the ___ of health services to members

Back 29

Cost, Delivery

Front 30

The Goals of managed Care includes all of the following except

Back 30

Medical Care that is rendered in the least restrictive setting

Front 31

Managed care systems ensure the delivery of high-quality Care while managing costs through

Back 31

networks of providers, Discounted Fees

Front 32

Terms used to refer to fees in an insurance contract include all of the following except

Back 32

ordinary

Front 33

to determine the amount due from a patient it is necessary to know the

Back 33

allowed amount

Front 34

which of the following plan types does not use a network of providers

Back 34

indemnity plan

Front 35

in a managed care organization, a primary care physician is typically any of ht following except

Back 35

dermatologist

Front 36

The Duties of a primary care physician in a health maintenance organiztion include

Back 36

all of the above

Front 37

types of managed care plans are

Back 37

HMO, PPO, POS

Front 38

The fixed dollar amount a member pays at each office visit or hospital encounter is called

Back 38

copayment

Front 39

Primary care physicians in a health maintenced organizations can include

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family practice, general practice, internal medicine and OB/Gyn

Front 40

In managed care contracts Pmpm refers to

Back 40

per member per month

Front 41

A feature of a preferred provider organization includes which of the following

Back 41

Both a nd B

Front 42

a point of service plan allows members to

Back 42

both a nd b

Front 43

incentives for PPO members to use network providers include

Back 43

Lower out of pocket costs

Front 44

which of the following is true of self insured plans

Back 44

all of the above

Front 45

The type of insurance coverage that provides protection against a certain type of accident or illness

Back 45

special risk