60 terms

Insurance Review

A copayment is a sum of money paid at the time of the medical sevice and is a form of co-insurance
An established schedule of fees set for services performed by providers and paid by the patient is called an indemnity plan
The person responsible for paying the medical bill is always the patient
An organization that contracts with the government to handle and mediate insurance claims from medical facilities or providers is called fiscal intermediary
Medicare was established in 1995
A medical savings account can be established only if the individual does not hae any other health insurance
Liability insurance never covers medical expenses
Plaans that provide benefits in the form of certain surgical and medical services rendered rather than cash are called service benefit plans
A person who is blind may be covered my medicare
The world's largest insurance program is medicaid
The amount of money paid to keep an insurance policy in force is the...
Approximately what percent of people in the US have no health insurance coverage?
Health insurance designed for military dependents and retired military personnel is...
Veterans of the US armed forces may be covered by...
group coverage
A policy that covers a number of people under a single master contract issued to the employer or an association with which they are affliliated and that is not self-funded is usually called...
self-insured plans
Organizations that fund their own insurance programs offer their employees...
third-party payors
Entities that make payment on an obligation or debt but are not parties of the contract that created the debt are called...
allowed charge
The maximum amount of money that third-party payors will pay for a specific prcedure or service is called the...
The federal and state sponsered health insurance program fro the medically indigent is called...
participating provider
The physician who enters into a contract with an insurance company and agrees to certain rules and regulations is called a...
utilization review
A review of individual cases by a committee to make sure that services are medically neccessary and to study how providers use medical care resources is called an...
The amount of money that the policyholder pays per claim or per accident toward the total amount of an insured loss before the company will pay on the claim is known as the...
major medical
Formerly called catastrophic insurance, which type of protection provides coverage for especially large medical bills resulting from a prolonged illness?
access to specialized care and referrals is limited
Which of the following is not an advantage of managed care?
authorized services are usuallty paid for
Which of the following is not a disadvantage of managed care?
independent practice association
Which type of HMO model consists of physicians with seperately owned practices who formally organize into a group but continue to practice in their own offices?
a 23 year old recipient of AFDC
Which of the following individuals would not be normally eligible for medicare?
physician office visits
Which of the following expenses would be paid by medicare part b?
Which part of medicare covers prescriptions drug services?
All of the above
Which of the following is a type of insurance verification method?
remittance advice
A document that explains what expenses were paid after submission to medicare and sent to the physician's office is called an...
worker's compensation
A type of insurance that protects workers from loss of wages after an industrial accident that happened on the job is called...
special risk
Insurance that protects a person in the event of a certain type of accident, such as an automobile or plane crash, is called ________ insurance?
all of the above
Health insurance benefits are determined by...
The TRICARE option that is similar to a preferred provider network is TRICARE...
Which type of referral is usually processed immediately?
If Mr. Jones insurance has a $500 deductible and a $50 surgery copay, how much will his insurance pay on his bill of $4359.00?
If Mr. Jones insurance has a $500 deductible and a $50 surgery copay then pays 80% of the charges, how much will his policy pay on his bill of $4359.00?
The individual entitled to receive benefits from an insurance policy or program is called the?
A payment method in which providers are paid for each enrolled individual in a plan whether ot not he or she sees the provider that motnh is called a ________ plan?
A term used in managed care for an approved referral is....
When an indvidual is covered by 2 policies and the provider needs to know which policy is primary, refer to the _______ rule?
Companies that assume the risk of an insurance policy are called...
The date on which the insurance policy will begin to pay for benefits is the _____ date.
Limitations on an insurance contract for which benefits are not payable are called...
A _____ is a spouse, child and sometimes a domestic partner of an insured person.
The process required by some insurance carriers by which the provider obtains permission to perform certain procedures or services is called.....
The insurance term used when a provider sends a patient to another provider for consultation is a...
A special provision or group of provisions attatched to an insurance policy to expand or limit coverage is called a....
The periodic payment for insurance coverage is called a......
The medical assistant must obtain _____ information on patients during their first visit.
_____ care plans usually cover about 1/2 of major services and often pay preventative services at 100%.
The _____ is the individual responsible for the payment for medical services.
Managed care _______ include the PPO and HMO.
A traditional health in=surance plan that pays for all of a share of the cost of covered services is called an ________ plan.
The law developed to improve the protibility and continuity of health insurance coverage is called _____.
Third-party ______ make payment on an obligation or debt but are not the parties of the contract that created the debt.
Workers _____ insurance covers employees in case of on the job injuries.
The amounts payable by an insurance company for a monetary loss to an individual insured by that company are called ________ .
A fiscal ____ contracts with the government to handle and mediate insurance claims from medical facilities and other providers of medical services or supplies.