question

The insurance industry is among the world's largest businesses

answer

Which statement is correct regarding the insurance industry

question

civil law

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most legal issues of private health insurance claims fall under

question

when the physician accepts the patient and agrees to treat the patient

answer

when does the physician/patient contract begin

question

implied

answer

most physician/patient contracts are

question

physician and the patient

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When a patient carries private medical insurance, the contract for treatment exists between the

question

younger than the age of 18 who lives independently

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an emancipated minor is a person

question

physician and the insurance company

answer

the contract in a workers compensation case exists between the

question

subscriber, member, policy holder

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in health insurance, the insured is also known as the

question

individual enrollee or organization protected

answer

the insured is always the

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noncancelable

answer

A policy in which the insurer cannot increase premium rates and must renew the policy until the insured reaches the age specified in the contract is a _______ policy.

question

prevent duplication or overlapping of payments for the same medical expense.

answer

the reason for a coordination of benefits statement in a health insurance policy is to

question

coordination of benefits

answer

Mr. Talili has two medical insurance policies. to prevent duplication of payment for the same medical expense, the policies include a ______ statement.

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court system

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in cases of divorce, the decision as to which parent should be responsible for payment of the child's services should be made by the

question

the health plan of the person whose birthday (month and day) falls earlier in the calendar year will pay first

answer

if a child has health insurance coverage from two parents, according to the birthday law

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plan of the person who has coverage longer is the primary payer

answer

according to the birthday law if both the mother and the father have the same birthday, the

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preexisting

answer

conditions that existed and were treated before the health insurance policy was issued are called

question

waiver

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an attachment to an insurance policy that excludes certain illnesses or disabilities that would otherwise be covered is referred to as a

question

preauthorization

answer

what is the correct term used to determine if a procedure is covered and medically necessary

question

conversion

answer

mrs. thompsett leaves her place of employment. she is eligible to transfer her medical insurance coverage from a group to an individual contract this is known as _____ privilege

question

benefits would be increased

answer

why would conversion from a group policy to an individual policy be advantageous

question

extend group health insurance coverage for 18 months

answer

mr. Ott was laid off from his job. he is protected by consolidated omnibus budget reconciliation act (COBRA), which requires his employer to

question

20

answer

What is the minimum number of employees a company must have to meet the criteria of the COBRA for continued medical benefits if an employee is laid off from a company

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HIPAA

answer

the act created to protect workers and their families so that they can get and maintain health insurance if they change or lose their jobs is called the

question

foundation for medical care

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an organization of physicians, sponsored by a state or local medical association, concerned with the development and delivery of medical services and the cost of health care is known as a

question

competitive medical plan (CMP)

answer

a type of managed care organization created by the 1982 tax equity and fiscal responsibility act (TEFRA) that allows for enrollment of medicare beneficiaries into managed care plans is to a

question

maternal and child health programs (MCHP)

answer

a state and federal program for children who are younger than 21 years of age and have special health care needs is

question

patient registration form

answer

A patient intake sheet is also called a

question

patient information form

answer

The first document obtained in the initial patient visit is a

question

the transfer of ones legal right to collect an amount payable under an insurance contract

answer

assignment of benefits is

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patient service slip

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an encounter form may also be known as a

question

superbill

answer

the source document for insurance claim data is the

question

day sheet

answer

a daily record sheet used to record daily business transactions is called a

question

more than 10

answer

under HIPAA guidelines, physicians must send all claims electronically if they have _____ full-time employees

question

follow-up of insurance claims

answer

an insurance claims register facilitates

question

be sent a monthly statement indicating the insurance company has been billed

answer

when the physicians services have been submitted to the patients insurance company by the physicians office, the patient should

question

a medical capitation plan in which treatment is delivered via a clinic or independent physician that provides a number of basic medical services for a fixed capitation payment per month

answer

independent practice association (IPA)

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a program sponsored jointly by federal and state governments for medically indigent persons, aged individuals who meet certain financial requirements, and the disabled

answer

medicaid

question

insurance that covers off the job injury or sickness and is paid by deductions from a persons paycheck

answer

state disability or unemployment compensation disability (UCD)

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government sponsored program that provides hospital and medical services for dependents of active duty uniform service members, military retirees and their families, and survivors of uniformed services

answer

tricare

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a contract that insures a person against on the job injury or illness

answer

workers compensation insurance

question

provides coverage for spouses and children of veterans with total, permanent, service connected disabilities or for the surviving spouses and children of veterans who died as a result of service connected disabilities

answer

CHAMPVA

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an organization that provides a wide range of comprehensive health care services for a specified group at a fixed periodic payment

answer

health maintenance organization (HMO)

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a form of health insurance that provides periodic payments to replace income when the insured is unable to work as a result of illness, injury, or disease

answer

disability income insurance

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the hospital insurance system and supplementary medical insurance for those older than 65 years of age, created by the 1965 Amendments to the social security act

answer

medicare

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renders a service to a patient

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treating or performing physician

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directs selection, preparation, and administration of tests, medication, or treatment

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ordering physician

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legally responsible for the care and treatment given to a patient

answer

attending physician

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gives an opinion regarding a specific problem that is requested by another doctor

answer

consulting physician

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sends the patient for tests or treatment or to another physician for consultation

answer

referring physician

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oversees care of patients in managed care plans and refers patients to see specialists when needed

answer

primary care physician

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responsible for training and supervising medical students

answer

teaching physician

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clinical nurse specialist or licensed social worker who treats a patient for a specific medical problem and uses the results of a diagnostic test in managing a patients medical problem

answer

non physician practitioner

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performs one or more ears of training in a specialty area while working at a hospital (medical center)

answer

resident physician

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right lower quadrant

answer

RLQ

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discharge

answer

DC

question

within normal limits

answer

WNL

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rule out

answer

R/O

question

upper respiratory infection

answer

URI

question

with

answer

C (line on top)

ch. 3 and 4 medical insurance – Flashcards

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