5 Written questions
5 Matching questions
- Medigap (Medifill)
- Explanation of Benefits (EOB)
- Member Physician
- a Transference of words into numbers to facilitate the use of computers in claim processing.
- b Private insurance to supplement Medicare benefits for noncovered services.
- c A physician who has contacted to participate with an insurance company to be reimbursed for services according to the company's plan.
- d A request for payment.
- e A printed description of the benefits provided by the insurer to the beneficiary.
5 Multiple choice questions
- 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.
- A list of approved professional services for which the insurance company will pay with the maximum fee paid for each service.
- 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.
- A predetermined amt. that the insured must pay each year before the insurance company will pay for an accident of illness.
- 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.
5 True/False questions
Current Procedural Terminology Code (CPT) → 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).
Admitting Physician → The physician who cares for a pt in the hospital (not necessarily the physician who admitted the pt)
Utilization Management → 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.
Third Party Payer → A term given to a primary care physician for coodinating the pt's care to specialists, hospital admissions and so on.
Internal Classification of Diseases, Revision, Clinical Modification (ICD) → The coding system used to document diseases, injuries, illness and mortalities.