Insurance chapter 3 multiple choice – Flashcards
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the insurance industry is among the worlds largest businesses.
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which statement is correct regarding the insurance industry?
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civil law
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most legal issues of private health insurance claims fall under
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when the physician accepts the patient and agrees to treat the patient.
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when does the physician/patient contract begin?
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implied
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most physician/patient contracts are?
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the physician and the patient
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when a patient carries private medical insurance, the contract for treatment exists between
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a person younger that the age of 18 who lives independently
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an emancipated minor is?
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the physician and the insurance company
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the contract in a workers compensation case exists between?
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all of the above
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in health insurance, the insured is also known as?
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the individual enrollee or organization protected
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the insured is always?
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to prevent duplication or overlapping of payments for the same medical expense.
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the reason for a coordination of benefits statement in a health insurance policy is?
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coordination of benefits statement.
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Mr. Talili has two medical insurance policies. to prevent duplication of payment for the same medical expense, the policies include a?
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all of the above
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when a medical facility is sent correct reimbursement from an insurance company for professional services, the site receives.
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the health plan of the person whose birthday (month and day) falls earlier in the calender year will pay first.
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if a child has health insurance coverage from two parents, according to the birthday law
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the plan of the person who has coverage longer is the primary payer.
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according to the birthday law, if both mother and father have the same birthday?
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preexisting
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conditions that existed and were treated before the health insurance policy was issued are called?
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waiver
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an attachment to an insurance policy that excludes certain illness or disabilities that would otherwise be covered is referred to as a?
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preauthorization
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what is the correct term used to determine if a procedure is covered and medically necessary?
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conversion privilege
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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?
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no physician examination is required
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why would conversion from a group policy to an individual policy be advantageous ?
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extend group health insurance coverage for 18 months
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Mr. Ott was laid off from his job. He is protected by COBRA, which requires his employer to
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20
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what is the minimum number of employees a company must have to meet the criteria of the consolidated omnibus budget reconciliation act (cobra) for continued medical benefits if an employee is laid off from a company?
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health insurance portability association (IPA)
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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?
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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?
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competitive medical plan (CMP)
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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 a?
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maternal and child health programs (MCHP)
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a state and federal program for children who are younger than 21 years of age and have special health care needs is?
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patient registration form
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a patient intake sheet is also called a?
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patient information form
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the first document obtained in the initial patient visit is a?
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the transfer of ones legal right to collect an amount payable under an insurance contract
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assignment of benefits is
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patient service slip
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an encounter form may also be known as a
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superbill
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the source document for insurance claim data is the?
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day sheet
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a daily record sheet used to record daily business transactions is called a?
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in batches, grouping claims of patients who have the same type of insurance coverage.
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it is advisable to process insurance claims?
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follow-up of insurance claims
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an insurance claims register facilitates
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be sent a monthly statement indicating the insurance company has been billed.
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when the physicians services have been submitted to the patients insurance company by the physicians office the patient should
