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5 Written questions

5 Matching questions

  1. Fee Schedule
  2. Subscriber
  3. Group Insurance
  4. Utilization Management
  5. Health Maintenance Organization (HMO)
  1. a The person who has been insured, and insurance policy holder.
  2. b Insurance offered to all employees by and employer.
  3. c A panel that tracks what their members receive and checks if their medical care meets the standards of the organization.
  4. d A list of approved professional services for which the insurance company will pay with the maximum fee paid for each service.
  5. e A prepaid group practice serving a secific geographic area.

5 Multiple choice questions

  1. A predetermined amt. that the insured must pay each year before the insurance company will pay for an accident of illness.
  2. A printed form containing a list of the services with corresponding codes.
  3. Insurance purchased by an individual for self and any eligible dependents.
  4. 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.
  5. 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

  1. Accounts ReceivableThe total amt. owed by the practice to suppliers and other service providers.

          

  2. Utilization ReviewA panel that tracks what their members receive and checks if their medical care meets the standards of the organization.

          

  3. CapitationThe 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.

          

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

          

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