Chpt 1 & 2 Ins.Test Review

27 terms by lsauvron

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If the insuranc eplan has a hold harmless clause; it means

the patient is not responsible for paying what the insurance plan denies

The process of reporting diagnoses, procedures, and services as numeric and alphanumeric characters on teh insurance claim is called:

coding

If preauthorization for treatment by specialists and post-treatment reports were not filed, the claim would be:

denied

Another name for health insurance specialist is:

reimbursement specialist

electronic claims processing

Providers who send data in a standardized machine-readable format to an insurance company via disk, telephone modem, or cable are implementing

ICD-9-CM stands for

International Classification of Diseases - Ninth Revision, Clinical Modification

What does CPT stand for

current procedural terminology

The CPT manual is published by the

American Medical Association

disability insurance

Reimbursement for income lost as a result of temporary or permanent illness or injury is

cover the cost of medical care for traumatic injuries or lost wages

Liability insurance claims are made to

Workers compensation

Program that is mandated by federal and state governments that requires employers to cover medical expenses and loss of wages for workers who are injured on the job?

California

The first Blue Shield plan was founded in

group health insurance

Health care coverage available through employers and other organizations in which employers usually pay part of all of the premium costs is

major medical insurance

Type of insurance that provides coverage for catastrophic or prolonged illness and injuries

Protects all employees against injuries in the workplace

Occupational Safety and Health Administration Act of 1970 was designed to

Medicare

Requires physician offices to submit ICD-9-CM codes on CMS-1500 claim forms

Health Insurance Portability and Accountability Act of 1996

Act that mandates regulations that govern privacy, security, and electronic transactions standards for health care information?

CLIA

standards of laboratory testing

Medicaid

Title XIX of the SSA of 1965

Insurance

contract that protects from loss

Coinsurance

percentage of cost patient shares with the health plan

NCCI

promotes correct coding methodologies

Base period

weekly benefit amount divided into quarters

major medical insurance

coverage for prolonged illnesses and injuries

copay

specified amount paid for each physician visit

Medicare

XVII of the SSA of 1965

prepaid health plans

forerunner of today's managed care plans

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