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5 Written questions

5 Matching questions

  1. Coding
  2. Medigap (Medifill)
  3. Explanation of Benefits (EOB)
  4. Claim
  5. Member Physician
  1. a Transference of words into numbers to facilitate the use of computers in claim processing.
  2. b Private insurance to supplement Medicare benefits for noncovered services.
  3. c A physician who has contacted to participate with an insurance company to be reimbursed for services according to the company's plan.
  4. d A request for payment.
  5. e A printed description of the benefits provided by the insurer to the beneficiary.

5 Multiple choice questions

  1. 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.
  2. A list of approved professional services for which the insurance company will pay with the maximum fee paid for each service.
  3. 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.
  4. A predetermined amt. that the insured must pay each year before the insurance company will pay for an accident of illness.
  5. 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

  1. 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).

          

  2. Admitting PhysicianThe physician who cares for a pt in the hospital (not necessarily the physician who admitted the pt)

          

  3. Utilization ManagementA 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.

          

  4. Third Party PayerA term given to a primary care physician for coodinating the pt's care to specialists, hospital admissions and so on.

          

  5. Internal Classification of Diseases, Revision, Clinical Modification (ICD)The coding system used to document diseases, injuries, illness and mortalities.