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27 terms

Chpt 1 & 2 Ins.Test Review

STUDY
PLAY
If the insuranc eplan has a hold harmless clause; it means
the patient is not responsible for paying what the insurance plan denies
The process of reporting diagnoses, procedures, and services as numeric and alphanumeric characters on teh insurance claim is called:
coding
If preauthorization for treatment by specialists and post-treatment reports were not filed, the claim would be:
denied
Another name for health insurance specialist is:
reimbursement specialist
electronic claims processing
Providers who send data in a standardized machine-readable format to an insurance company via disk, telephone modem, or cable are implementing
ICD-9-CM stands for
International Classification of Diseases - Ninth Revision, Clinical Modification
What does CPT stand for
current procedural terminology
The CPT manual is published by the
American Medical Association
disability insurance
Reimbursement for income lost as a result of temporary or permanent illness or injury is
cover the cost of medical care for traumatic injuries or lost wages
Liability insurance claims are made to
Workers compensation
Program that is mandated by federal and state governments that requires employers to cover medical expenses and loss of wages for workers who are injured on the job?
California
The first Blue Shield plan was founded in
group health insurance
Health care coverage available through employers and other organizations in which employers usually pay part of all of the premium costs is
major medical insurance
Type of insurance that provides coverage for catastrophic or prolonged illness and injuries
Protects all employees against injuries in the workplace
Occupational Safety and Health Administration Act of 1970 was designed to
Medicare
Requires physician offices to submit ICD-9-CM codes on CMS-1500 claim forms
Health Insurance Portability and Accountability Act of 1996
Act that mandates regulations that govern privacy, security, and electronic transactions standards for health care information?
CLIA
standards of laboratory testing
Medicaid
Title XIX of the SSA of 1965
Insurance
contract that protects from loss
Coinsurance
percentage of cost patient shares with the health plan
NCCI
promotes correct coding methodologies
Base period
weekly benefit amount divided into quarters
major medical insurance
coverage for prolonged illnesses and injuries
copay
specified amount paid for each physician visit
Medicare
XVII of the SSA of 1965
prepaid health plans
forerunner of today's managed care plans