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of 38 available terms

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5 Written Questions

5 Matching Questions

  1. Precertification
  2. Accounts Receivable
  3. Gatekeeper
  4. Managed Care
  5. TRICARE-Civilian Health and Medical Program of the Uniformed Services (CHAMPUS)
  1. a A 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.
  2. b The total amt. of all charges for services rendered to pt's that have not been paid to the physician.
  3. c Prior authorization must be obtained before the pt is admitted to the hospital or some specified outpatient or in-office procedures.
  4. d 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.
  5. e A term given to a primary care physician for coodinating the pt's care to specialists, hospital admissions and so on.

5 Multiple Choice Questions

  1. Insurance Carrier.
  2. A prepaid group practice serving a secific geographic area.
  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. 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)
  5. 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.

5 True/False Questions

  1. Encounter Form (Superbill)A printed form containing a list of the services with corresponding codes.


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


  3. DeductibleA predetermined amt. that the insured must pay each year before the insurance company will pay for an accident of illness.


  4. Walkout StatementA printed form with the pt's charges and the amt. paid for the servces rendered, which the pt takes with her. (receipt)


  5. Attending PhysicianThe physician who cares for a pt in the hospital (not necessarily the physician who admitted the pt)


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