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5 Written questions

5 Matching questions

  1. Claim
  2. Encounter Form (Superbill)
  3. TRICARE-Civilian Health and Medical Program of the Uniformed Services (CHAMPUS)
  4. Accounts Payable
  5. Preferred Provider Organization (PPO)
  1. a A request for payment.
  2. b Established to aid dependents of active service personnel, retired servces personnel and their dependents, dependents of services personnel who died on active duty, with a supplement for medical care in military or public health service facilities.
  3. c The total amt. owed by the practice to suppliers and other service providers.
  4. d A printed form containing a list of the services with corresponding codes.
  5. e This plan offers different insurance coverage depending on whether the pt receives services from a contracting network or non-network physician. The benefits are higher if the physician provider is a member of the PPO (or is a network physician).

5 Multiple choice questions

  1. The health care provider is automatically paid a fixed amt. per month regardless of provided services for each pt who is a member of a particular insurance organization.
  2. A prepaid group practice serving a secific geographic area.
  3. Insurance offered to all employees by and employer.
  4. A printed description of the benefits provided by the insurer to the beneficiary.
  5. The physician who admits a pt to the hospital (not necessarily the pt's attending physician)

5 True/False questions

  1. Assignment of BenefitsProcedures used by insurers to avoid ducplication of payment on claims when the pt has more than one policy. one insurance becomes the primary payer and no more than 100% of the costs are covered.

          

  2. Utilization ManagementA panel that tracks what their members receive and checks if their medical care meets the standards of the organization.

          

  3. Coodination of Benefits (COB)Procedures used by insurers to avoid ducplication of payment on claims when the pt has more than one policy. one insurance becomes the primary payer and no more than 100% of the costs are covered.

          

  4. Member PhysicianThe physician who admits a pt to the hospital (not necessarily the pt's attending physician)

          

  5. Third Party PayerA system of medical team members organized into groups to provide quality and cost-effective care that encompasses both the delivery of health care and payment of the services.

          

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