question

Benefits

answer

In excange for the permium that the policyholder pays, the health plan agrees to pay amounts for the medical services called

question

Coinsurance

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Is the percentage of the charges an insured person must pay for health care service after the deductible has been meet

question

Policyholder

answer

Coinsurance is paid by the

question

copayment

answer

Is the amount that a person insured in a manged care plan must pay for each office visit

question

Hold down health care costs

answer

Cost-containment practices are designed to

question

Deductible

answer

Is the amount the insured must pay before receiving benefits from the insurance policy

question

Dependent

answer

person who is also covered under an insured person's policy is called a(n)

question

Diagnosis

answer

A provider's analysis of a patient's illness or injury is called

question

remittance advice

answer

Is a health plan document that provides details about how a patient's claim was handled

question

Remittance advice

answer

RA is the abbreviation for

question

Fee-for-service

answer

Are benefits paid based on the fees physician charge for the services

question

health care claim

answer

Is a formal insurance claim, either electronic or hard copy format, witch is filed with the payer (insurance carrier) by many medical offices on behalf of their patients to receive payments

question

Health Plans

answer

Are orgabizations that offer protection in case of illness or accidental injury

question

Managed care organizations

answer

are organizations that offer health plans that combine the financing and delivery of health care servies

question

Medical Insurance

answer

Is a financial plan that covers the cost of hospitalization and medical care due to illness or injury

question

Patient information form

answer

is a form that contains demographic information about a patient

question

Policyholder

answer

is a person who buys an insurance plan

question

Preauthorization

answer

When a health plan has apporved a procedure before it is done, this process is called

question

Provider

answer

A _____ is a person or entity that supplies medical or health services

question

Schedule of benefits

answer

A list of covered services that an insurance policy covers is called

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Covered services

answer

Are medical procedures and treatments included as benifits in a health plan

question

Copayment

answer

Is a small fixed fee paid by the policyholder/patient at the time of each office visit

question

Payer

answer

is the third party in the medical insurance relationship who carries some of the risk of paying for services on the behalf of the beneficiaries

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Payers

answer

are private or goverment organizations that insure or pay for health care on behalf of beneficiaries

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the patient's diagnosis and procedures received are logically linked

answer

Medically necessary means

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Medically necessary

answer

means treatmentes that are appropriate and rendered in accordance with generally accepted standards of medical practice

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Ethics

answer

are the standards of behavior requiring truthfulness, honesty, and integrity

question

Ethics

answer

Are standards of conduct based on moral principles

question

Job-related illnesses and injuries

answer

Workers' compensation covers people with

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Their employer

answer

People with ijob-related illnesses or injuries are covered under workers' compensaton insurance through

question

Gathering basic demographic and insurance information about patients

answer

Preregistraton involves

question

Part of the patient checkout process

answer

Patient payments such as copayments are

question

actions that help to ensure the provider receives maximum appropriate payment

answer

Revenue cycle management (rcm) in volves

question

Health information technolgy is

answer

computer hardware and software information systems that record, store, and manage patient information

question

Practice management programs ( PMPS) are

answer

specialized accounting software programs used in many medical offices

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bill insurance companies and patients

answer

Practice management programs (PMPs) are used to

question

computer lifelong health care record for an individual

answer

an electrionc health record (EHR) is a

question

65

answer

Medicare covers people over the age of

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Illness

answer

Health plans offer finanical protection in the case of

question

receives the service

answer

A copayment is due when the patient

question

$70

answer

if a policyholder owes coinsurance of 30 percent and the charges are $100, what is the amount the insurance policy will pay

question

Patient

answer

Who pays for the excluded services

question

increased payments to providers

answer

in the United States, rising medical costs are due to

question

cost-containment practice

answer

an example of ___ is requiring patients to choose from a specific group of physicians

question

nonemergency hospitalization

answer

Manged care plans often require preauthorizaton for

question

Health care claims

answer

Policyholders receive insurance benefits when which of the following is filed

question

consumer-driven health plan

answer

is a type of managed care plan in witch a high-deductible low-permium insurance plan is combined with a pretax savings plan

question

denied clamis

answer

inaccurate health care claims result in

question

The managed care organization

answer

fees are set by ____ under a managed care plan

question

copayment

answer

copay is the shortened version of witch term

question

physicians

answer

in a fee-for-service plan, benefits are based on the fees charged for services by

question

procedures

answer

the services and treatments given by a licensed medical professional are called

question

etiquette

answer

correct behavior in the medical office is called

question

tricare

answer

the goverment sponsored insurance program for the families of military personnel is called

question

update them

answer

what should patients returning to a medical office periodically be asked to do with their patient information forms

question

Health savings account

answer

is the second element of a CPHP that is used to pay medical bills before the deductible has been met

question

both front and back

answer

what side(s) of the patients insurance identification card does a medical assistant usually scan or photocopey

question

medical billing cycle

answer

the process that results in timely payment for medical services is called

question

medicaid

answer

is for individuals with lower incomes who cannot afford medical care is cosponsored by the federal and state governments

question

CHAMPVA

answer

is the healtyh plan for the dependents of veterans with permanent service-related disabilities

question

CHAMPVA

answer

is the health plan that covers surviving spouses and dependent childern of veterans who died from service-related disabilities

question

preferred providers organization

answer

is a type of manged care health plan in witch a network of providers under contract with a managed care organization agree to perform services for plan members at discounted fees

question

health maintenance organization

answer

is a type of manged care system in which providers are paid fixed rates at regular intervals to provide necessary contracted services to patients who are plan members

question

Health maintenance organization

answer

HMO is the abbreviation for

question

preferred provider organization

answer

PPO is the abbreviation for

question

Chief complaint

answer

is the illness or condition that is the reason a patient needs to see the physician

question

certification

answer

recognition of a superior level of skill by an official organization is called

question

statement

answer

shows services provided to a patient,total payments made, total charges, adjustments, and balance due

question

e-claims

answer

are claims that are prepared and sent electronically

question

electronic health record and practice management program

answer

PM/EHR is a software program that combines

question

coding

answer

is the process of translating a description of a diagnosis or procedure into standardized code

question

adjudication

answer

is when a claim goes through a series of steps that are designed to determine wheather the claim should be paid

question

routine cancer screening

answer

whitch one of the following is considered preventive medical services

question

third-party payer

answer

is a private or goverment organization that insures or pays for health care on the behalf of beneficiaries

question

account receivable

answer

are monies that are owed to the practice

question

accounts payable

answer

are a medical practices operating expenses

Chapter 1 Insurance In the medical office Seventh ed – Flashcards

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