NAME: ________________________

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5 Written Questions

5 Matching Questions

  1. Gatekeeper
  2. Individual Insurance
  3. Group Insurance
  4. Explanation of Benefits (EOB)
  5. Copayment or Coinsurance
  1. a A specified amt. that the insured must pay toward the charge for professional services rendered.
  2. b A printed description of the benefits provided by the insurer to the beneficiary.
  3. c A term given to a primary care physician for coodinating the pt's care to specialists, hospital admissions and so on.
  4. d Insurance offered to all employees by and employer.
  5. e Insurance purchased by an individual for self and any eligible dependents.

5 Multiple Choice Questions

  1. Coding system published by the american medical association that translates services received by a pt into a numeric value for convenience and continiuity of reporting these services to third parties for payment. The system is recognized by governmental payers and private insurance companies. (*always 5 digits ex:25000)
  2. Routine tests required for all pt's before hospital admission to screen for abnormal findings that could interfere with the pt's hospital stay or scheduled procedure.
  3. 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).
  4. The total amt. owed by the practice to suppliers and other service providers.
  5. A predetermined amt. that the insured must pay each year before the insurance company will pay for an accident of illness.

5 True/False Questions

  1. CMS 1500Transference of words into numbers to facilitate the use of computers in claim processing.

          

  2. Health Maintenance Organization (HMO)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).

          

  3. Skilled Nursing FacilityThe physician who cares for a pt in the hospital (not necessarily the physician who admitted the pt)

          

  4. ClaimA request for payment.

          

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

          

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