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5 Written questions

5 Matching questions

  1. Fee Schedule
  2. Member Physician
  3. Health Maintenance Organization (HMO)
  4. Copayment or Coinsurance
  5. Coodination of Benefits (COB)
  1. a A list of approved professional services for which the insurance company will pay with the maximum fee paid for each service.
  2. b A physician who has contacted to participate with an insurance company to be reimbursed for services according to the company's plan.
  3. c A prepaid group practice serving a secific geographic area.
  4. d 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.
  5. e A specified amt. that the insured must pay toward the charge for professional services rendered.

5 Multiple choice questions

  1. The standard claim form
  2. The total amt. owed by the practice to suppliers and other service providers.
  3. A review carried out by allied health professionals at predetermined times to assess the necessity of the particular pt to remain in an acute care facility.
  4. Established in 1973 for the spouses and dependent children of veterans who have total, permanent, service-connected disabilities.
  5. A term given to a primary care physician for coodinating the pt's care to specialists, hospital admissions and so on.

5 True/False questions

  1. SubscriberThe person who has been insured, and insurance policy holder.


  2. Individual InsuranceInsurance purchased by an individual for self and any eligible dependents.


  3. PrecertificationThe 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.


  4. Preadmission Testing (PAT)The physician who admits a pt to the hospital (not necessarily the pt's attending physician)


  5. Assignment of BenefitsThe authorized signature of the pt for payment to be paid directly to the physician for services.


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