5 Written Questions
5 Matching Questions
- Individual Insurance
- Group Insurance
- Explanation of Benefits (EOB)
- Copayment or Coinsurance
- a A specified amt. that the insured must pay toward the charge for professional services rendered.
- b A printed description of the benefits provided by the insurer to the beneficiary.
- c A term given to a primary care physician for coodinating the pt's care to specialists, hospital admissions and so on.
- d Insurance offered to all employees by and employer.
- e Insurance purchased by an individual for self and any eligible dependents.
5 Multiple Choice Questions
- 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)
- 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.
- 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).
- The total amt. owed by the practice to suppliers and other service providers.
- 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
CMS 1500 → Transference of words into numbers to facilitate the use of computers in claim processing.
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).
Skilled Nursing Facility → The physician who cares for a pt in the hospital (not necessarily the physician who admitted the pt)
Claim → A request for payment.
Utilization Review → A panel that tracks what their members receive and checks if their medical care meets the standards of the organization.