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5 Written questions

5 Matching questions

  1. Managed Care
  2. Utilization Management
  3. Internal Classification of Diseases, Revision, Clinical Modification (ICD)
  4. Walkout Statement
  5. Member Physician
  1. a The coding system used to document diseases, injuries, illness and mortalities.
  2. b A panel that tracks what their members receive and checks if their medical care meets the standards of the organization.
  3. c A printed form with the pt's charges and the amt. paid for the servces rendered, which the pt takes with her. (receipt)
  4. d A physician who has contacted to participate with an insurance company to be reimbursed for services according to the company's plan.
  5. e 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 Multiple choice questions

  1. Private insurance to supplement Medicare benefits for noncovered services.
  2. The person who has been insured, and insurance policy holder.
  3. A predetermined amt. that the insured must pay each year before the insurance company will pay for an accident of illness.
  4. 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).
  5. Insurance purchased by an individual for self and any eligible dependents.

5 True/False questions

  1. Coodination of Benefits (COB)A printed description of the benefits provided by the insurer to the beneficiary.

          

  2. Preadmission Testing (PAT)Routine tests required for all pt's before hospital admission to screen for abnormal findings that could interfere with the pt's hospital stay or scheduled procedure.

          

  3. GatekeeperThe person who has been insured, and insurance policy holder.

          

  4. CodingTransference of words into numbers to facilitate the use of computers in claim processing.

          

  5. Assignment of BenefitsA printed description of the benefits provided by the insurer to the beneficiary.

          

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