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Chapter 16 test ;1100
Terms in this set (49)
Capitation is a payment method used by theses types of health insurance plans.
Health Maintenance Organizations (HMOs)
A payment method in which providers are paid for each enrolled individual in a plan whether or not he or she sees the provider that month is called
A __________ is a spouse, child, and sometimes domestic partner of insured person
Which of the following best describes insurance policies that provide coverage on a fee-for-service basis ?
Which of the following would be typically covered by Medicaid insurance?
5-year old in a single family home
The physician who enters into a contract with an insurance company and agrees to certain rules and regulations is called a
A participating (in-network) provider in a manager health-care program must write off:
Difference between the fee and allowed amount
Bob Johnson goes to his in-network/ participating HMO provider for a checkup and a flu shot. The allowed charge for a checkup is $80, and the physician's usual fee is $85. The allowed charge for the flu shot is $40, and the physician's usual fee is $50. How much is Mr. Johnson charged for the visit?
Formerly called catastrophic insurance, which type of protection provides coverage for especially large medical bills resulting from prolonged illness ?
Which of the following best describes insurance policies that require policyholders to select a primary care provider?
Health Maintenance Organization
Which of the following applies to a method of containing hospital costs and length of stay that is based on an average cost for treatment of a patient's condition?
Diagnostically related groups
Health insurance was designed for what reason ?
to help individuals and families compensate for high medical costs
The federal and state- sponsored health insurance program for medically indigent is called
Which of the following applied to medical insurance for dependents of active duty or retired military personnel and their dependents?
The amount of charges the provider would have to write off if insurance didn't cover it is known as what?
Which of the following terms is applied when more than one policy covers an individual?
coordination of benefits
If the employer operates its own health plan instead of purchasing a plan from an insurance company to cover its employees, what type of plan are they utilizing ?
Self-funded health care
The insurance term used when a provider sends a patient to another provider for consultation is
If a child is covered by both of her parents' insurance and the total medical charges come to $365, $280 of which is covered by the primary insurance, how are the rest of the charges handled?
A claim is submitted to secondary insurance for $85
Which of the following terms means an insurance policy pays a percentage of the balance after application of the deductible?
Of the following, which one is an example of coordination of benefits
Determining which plan is filedfirst.
A disease or disorder that was diagnosed prior to an insurance plan taking affect is known as
Which of the following applies to Medicare coverage that pays for prescription drugs ?
Entities that make payment on an obligation or debt but are not parties of the contract that created the debt are called (for example when insurance pays MD for services provided to the patient)
Which is the most common type of referral used by managed care ?
Most of today's health insurance policies cover which of the following ?
Both A and B
Which of the following is not a federal health insurance program?
Blue cross/ Blue shield
Which of the following would typically be an exclusion for insurance benefits?
Before certain procedures or visits can be made, some insurance policies require which of the following?
Prior authorization or precertification
Which of the following expenses would be paid by Medicare Part B ?
Physician office visits
A bill is never sent to a patient in which type of insurance?
A complex reimbursement system in which physician time, judgement, overhead, and liability are considered in calculating payment is known as ?
Resource-based relative valve scale (RBRVS)
A ______________ contracts with the government to handle and mediate insurance claims from medical facilities and other providers of medical services or supplies. Claims are sent locally for processing
The amount of money that the policyholder pays toward the total amount of an insurer loss (claim) before the insurance company will pay on this claim is known as the
The maximum amount of money that third-party payers will pay for a specific procedure or service is called the
Which of the following best describes policies that are supplementary to Medicare insurance?
The statement mailed to the patient summarizing how the insurance carrier determined the reimbursement is Janie as what ?
EOB ( explanation of benefits)
Which of the following best describes a network of providers and hospitals who have a contract with insurance companies to provide discounted health care ?
preferred provider organization
If a person is covered under both Medicare and Medicaid, to which program should the claim be sent first ?
Dr. Chad is a participating provider in Medicare. Does this mean Dr. Chad will accept assignment and what percent of the allowed amount?
The person responsible for paying the medical bill is known as the
Which of the following is a type of insurance coverage for persons injured on the job ?
Which of the following is applied to determine primary coverage for a dependent child when both parents are covered by healthy insurance
Each time a patient comes to the clinic, the medical assistant must verify which of the following insurance information?
whether insurance covers the procedure, what the patient's insurance plan is, whether a referral is required
Which of the following is medical insurance for the spouse and unmarried dependent children of a veteran with permanent total disability resulting from a service-related injury ?
The amount of money paid to keep an insurance policy active is the
A policy that covers a number of people under a single master contract issued to the employer or to an association with with they are affiliated and that is not self-funded is usually called
Which of the following is the purpose of screening new patients for insurance coverage?
verify patient has coverage and obtain vital billing information
The amount of money owed by insurer to the provider at the time of service is called
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