5 Written questions
5 Matching questions
- Fee Schedule
- Member Physician
- Health Maintenance Organization (HMO)
- Copayment or Coinsurance
- Coodination of Benefits (COB)
- a A list of approved professional services for which the insurance company will pay with the maximum fee paid for each service.
- b A physician who has contacted to participate with an insurance company to be reimbursed for services according to the company's plan.
- c A prepaid group practice serving a secific geographic area.
- 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.
- e A specified amt. that the insured must pay toward the charge for professional services rendered.
5 Multiple choice questions
- The standard claim form
- The total amt. owed by the practice to suppliers and other service providers.
- 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.
- Established in 1973 for the spouses and dependent children of veterans who have total, permanent, service-connected disabilities.
- 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
Subscriber → The person who has been insured, and insurance policy holder.
Individual Insurance → Insurance purchased by an individual for self and any eligible dependents.
Precertification → 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.
Preadmission Testing (PAT) → The physician who admits a pt to the hospital (not necessarily the pt's attending physician)
Assignment of Benefits → The authorized signature of the pt for payment to be paid directly to the physician for services.