5 Written questions
5 Matching questions
- Fee Schedule
- Group Insurance
- Utilization Management
- Health Maintenance Organization (HMO)
- a The person who has been insured, and insurance policy holder.
- b Insurance offered to all employees by and employer.
- c A panel that tracks what their members receive and checks if their medical care meets the standards of the organization.
- d A list of approved professional services for which the insurance company will pay with the maximum fee paid for each service.
- e A prepaid group practice serving a secific geographic area.
5 Multiple choice questions
- A predetermined amt. that the insured must pay each year before the insurance company will pay for an accident of illness.
- A printed form containing a list of the services with corresponding codes.
- Insurance purchased by an individual for self and any eligible dependents.
- 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 printed form with the pt's charges and the amt. paid for the servces rendered, which the pt takes with her. (receipt)
5 True/False questions
Accounts Receivable → The total amt. owed by the practice to suppliers and other service providers.
Utilization Review → A panel that tracks what their members receive and checks if their medical care meets the standards of the organization.
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.
Medicaid → Transference of words into numbers to facilitate the use of computers in claim processing.
Member Physician → The physician who cares for a pt in the hospital (not necessarily the physician who admitted the pt)