← Terms Test
5 Written Questions
5 Matching Questions
- Preferred Provider Organization (PPO)
- Coodination of Benefits (COB)
- Utilization Management
- Group Insurance
- a 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.
- b A panel that tracks what their members receive and checks if their medical care meets the standards of the organization.
- c Insurance offered to all employees by and employer.
- d 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).
- e Prior authorization must be obtained before the pt is admitted to the hospital or some specified outpatient or in-office procedures.
5 Multiple Choice Questions
- The standard claim form
- Established in 1973 for the spouses and dependent children of veterans who have total, permanent, service-connected disabilities.
- A specified amt. that the insured must pay toward the charge for professional services rendered.
- A physician who has contacted to participate with an insurance company to be reimbursed for services according to the company's plan.
- A list of approved professional services for which the insurance company will pay with the maximum fee paid for each service.
5 True/False Questions
Claim → Transference of words into numbers to facilitate the use of computers in claim processing.
Capitation → 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.
Attending Physician → The physician who cares for a pt in the hospital (not necessarily the physician who admitted the pt)
Explanation of Benefits (EOB) → A printed description of the benefits provided by the insurer to the beneficiary.
Medicaid → A predetermined amt. that the insured must pay each year before the insurance company will pay for an accident of illness.