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Study sets matching "health insurance chapter 7"

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Study sets matching "health insurance chapter 7"

87 terms
Understanding Health Insurance Chapter 7
Adjuvant Chemotherapy
Anesthesia time Unit
Appedix G
Appendix E
Chemotherapy administerd in addition to other cancer treatmen…
One 15-minute increment.
Summary of CPT codes that include moderate (conscious) sedati…
Codes exempt from modifier -51 reporting rules.
Adjuvant Chemotherapy
Chemotherapy administerd in addition to other cancer treatmen…
Anesthesia time Unit
One 15-minute increment.
13 terms
Chapter 7 - Health Insurance
Beneficiary
Benefits
Premiums
Deductible
Person who buys insurance
Services covered by insurance
Annual fee beneficiary pays usually in monthly installments
Amount beneficiary must pay before insurance company assists…
Beneficiary
Person who buys insurance
Benefits
Services covered by insurance
89 terms
Understanding Health Insurance Chapter 7
Adjuvant Chemotherapy
Anesthesia time Unit
Appedix G
Appendix E
Chemotherapy administerd in addition to other cancer treatmen…
One 15-minute increment.
Summary of CPT codes that include moderate (conscious) sedati…
Codes exempt from modifier -51 reporting rules.
Adjuvant Chemotherapy
Chemotherapy administerd in addition to other cancer treatmen…
Anesthesia time Unit
One 15-minute increment.
87 terms
Understanding Health Insurance Chapter 7
Adjuvant Chemotherapy
Anesthesia time Unit
Appedix G
Appendix E
Chemotherapy administerd in addition to other cancer treatmen…
One 15-minute increment.
Summary of CPT codes that include moderate (conscious) sedati…
Codes exempt from modifier -51 reporting rules.
Adjuvant Chemotherapy
Chemotherapy administerd in addition to other cancer treatmen…
Anesthesia time Unit
One 15-minute increment.
29 terms
Chapter 7 Health Insurance
Observation Services furnished in a ho…
What are Care plan oversight services…
Code for amniocentesis with radiologic…
What do you call the time the physicia…
hospital observation services
physician time
59001
unit/floor time
Observation Services furnished in a ho…
hospital observation services
What are Care plan oversight services…
physician time
Understanding Health Insurance Chapter 7
Adjuvant Chemotherapy
Anesthesia time Unit
Appedix G
Appendix E
Chemotherapy administerd in addition to other cancer treatmen…
One 15-minute increment.
Summary of CPT codes that include moderate (conscious) sedati…
Codes exempt from modifier -51 reporting rules.
Adjuvant Chemotherapy
Chemotherapy administerd in addition to other cancer treatmen…
Anesthesia time Unit
One 15-minute increment.
20 terms
Understanding Health Insurance: CHAPTER 7
Guidelines are located at the beginnin…
Of the following, which is/are section…
What types of codes contain "emerging…
Procedures and services submitted on a…
True
All of the above ... (Medicine, Pathology and Laboratory, Radiol…
Category III codes
ICD-9-CM code
Guidelines are located at the beginnin…
True
Of the following, which is/are section…
All of the above ... (Medicine, Pathology and Laboratory, Radiol…
27 terms
Health insurance II chapter 7
CMS-1500 (02-12)
Electronic claims
Dates
Checkmarks
The standard form used an excepted by all insurance companies…
95% or more claims are electronic. They are paid within 7 to…
Dates must be in eight digits (EX. MMDDYYYY)
The X must be placed in the middle of block no checkmarks
CMS-1500 (02-12)
The standard form used an excepted by all insurance companies…
Electronic claims
95% or more claims are electronic. They are paid within 7 to…
47 terms
Chapter 7: Understanding Health Insurance
Uncertainty
Health Insurance
Insurance exists because of
Risk
whether any events might affect a particular individual; in g…
protects individuals from medical costs from these unforeseea…
risk and uncertainty
the central concern in insurance, and insurance is purchased…
Uncertainty
whether any events might affect a particular individual; in g…
Health Insurance
protects individuals from medical costs from these unforeseea…
Chapter 7: Understanding Health Insurance
Uncertainty
Health Insurance
Insurance exists because of
Risk
whether any events might affect a particular individual; in g…
protects individuals from medical costs from these unforeseea…
risk and uncertainty
the central concern in insurance, and insurance is purchased…
Uncertainty
whether any events might affect a particular individual; in g…
Health Insurance
protects individuals from medical costs from these unforeseea…
87 terms
Understanding Health Insurance Chapter 7
Adjuvant Chemotherapy
Anesthesia time Unit
Appedix G
Appendix E
Chemotherapy administerd in addition to other cancer treatmen…
One 15-minute increment.
Summary of CPT codes that include moderate (conscious) sedati…
Codes exempt from modifier -51 reporting rules.
Adjuvant Chemotherapy
Chemotherapy administerd in addition to other cancer treatmen…
Anesthesia time Unit
One 15-minute increment.
18 terms
Health Insurance Today chapter 7
A complex healthcare system in which h…
Individuals who are members of a manag…
A group of healthcare providers workin…
A specific provider who oversees the t…
Managed Care
Enrollees
PPO
Primary Care Physicians
A complex healthcare system in which h…
Managed Care
Individuals who are members of a manag…
Enrollees
67 terms
Individual Health Insurance (chapter 7)
Uniform Individual Accident and Sickne…
What is the purpose of these provisions?
Entire Contract; Changes
No changes may be made to the policy w…
was developed by the National Association of Insurance Commis…
to define the rights and duties of both the insurer and the p…
states that the health insurance policy, together with a copy…
1. the express written agreement of both parties... 2. any chang…
Uniform Individual Accident and Sickne…
was developed by the National Association of Insurance Commis…
What is the purpose of these provisions?
to define the rights and duties of both the insurer and the p…
87 terms
Understanding Health Insurance Chapter 7
Adjuvant Chemotherapy
Anesthesia time Unit
Appedix G
Appendix E
Chemotherapy administerd in addition to other cancer treatmen…
One 15-minute increment.
Summary of CPT codes that include moderate (conscious) sedati…
Codes exempt from modifier -51 reporting rules.
Adjuvant Chemotherapy
Chemotherapy administerd in addition to other cancer treatmen…
Anesthesia time Unit
One 15-minute increment.
67 terms
UNDERSTANDING HEALTH INSURANCE CHAP 7
care plan oversight services
case management services
Category I codes
Category II codes
cover the provider's time supervising a complex and multidisc…
process by which an attending physician coordinates and super…
procedures/services identified by a five-digit CPT code and d…
optional performance measurement tracking codes that are assi…
care plan oversight services
cover the provider's time supervising a complex and multidisc…
case management services
process by which an attending physician coordinates and super…
33 terms
Health insurance chapter 7/8
American Medical Association
January 1
CPT codes
Medical necessity
First published CPT in 1966
when must new, revised, and deleted CPT codes be implemented?
used to report services and procedures performed on patients.
Procedures and services submitted on a claim must be linked t…
American Medical Association
First published CPT in 1966
January 1
when must new, revised, and deleted CPT codes be implemented?
26 terms
Ebony Surgeon Health Insurance Today Chapter 7
Network
Enrollees
HMO's and PPO's
Primary care physicians (PCP)
An organized, interrelated system of people and facilities yh…
Individuals belonging to a managed healthcare plan are referr…
The most common types of MCO's are:
A specific provider who oversees and HMO member's total healt…
Network
An organized, interrelated system of people and facilities yh…
Enrollees
Individuals belonging to a managed healthcare plan are referr…
26 terms
Health Insurance Billing Chapter 7
Reimbursement
Electronic Health (medical) record (EH…
(HIPAA) Health Insurance Portability a…
New patient
receiving payment for services rendered, is everybody's busin…
Patient registration and insurance billing are often the firs…
privacy and security rules have a direct impact on patient re…
a person who is being seen by a physician for the first time…
Reimbursement
receiving payment for services rendered, is everybody's busin…
Electronic Health (medical) record (EH…
Patient registration and insurance billing are often the firs…
38 terms
Accident, Life, and Health Insurance Chapter 7
Disability Income Insurance
Own occupation
Any Occupation
Presumptive Disability
Provides benefit payments to disabled individuals. Benefit pa…
disability income policies that pay benefits when the insured…
disability income policies that are more restrictive, requiri…
Condition such as loss of sight, hearing, speech, or use of a…
Disability Income Insurance
Provides benefit payments to disabled individuals. Benefit pa…
Own occupation
disability income policies that pay benefits when the insured…
35 terms
health insurance chapter 7 scilla07
category 1codes
category 2 codes
category 3 codes
consultation
procedures services indentified by a five dight cpt code and…
contain performance measurements tracking codes that are assi…
contain emerging technology temporary codes assigned an alpha…
is an examination of a patient a health care purpose of advis…
category 1codes
procedures services indentified by a five dight cpt code and…
category 2 codes
contain performance measurements tracking codes that are assi…
Understanding Health Insurance - Chapter 7 - CPT Coding Test
OVERVIEW OF CPT
CPT
AMA
Five-digit codes
Current Procedual Terminology {CPT} is a listing of descripti…
It provides a uniform language that describes medical, surgic…
American Medical Association first published CPT in 1966 and…
were introduced in 1970, replacing the four-digit classificat…
OVERVIEW OF CPT
Current Procedual Terminology {CPT} is a listing of descripti…
CPT
It provides a uniform language that describes medical, surgic…
Understanding Health Insurance - Chapter 7 - CPT Coding - Terms
OVERVIEW OF CPT
CPT
AMA
Five-digit codes
Current Procedual Terminology {CPT} is a listing of descripti…
It provides a uniform language that describes medical, surgic…
American Medical Association first published CPT in 1966 and…
were introduced in 1970, replacing the four-digit classificat…
OVERVIEW OF CPT
Current Procedual Terminology {CPT} is a listing of descripti…
CPT
It provides a uniform language that describes medical, surgic…
54 terms
HEALTH INSURANCE FOR MA CHAPTER 7 & 8
DATABASE
CLEAN CLAIM
HIPAA CLAIM
837P CLAIM
COLLECTION OF RELATED FACTS
CLAIM ACCEPTED BY A HEALTH PLAN FOR ADJUDICATION
HIPPA-MANDATED ELECTRONIC TRANSACTION FOR CLAIMS
HIPAA-MANDATED ELECTRONIC TRANSACTION FOR CLAIMS
DATABASE
COLLECTION OF RELATED FACTS
CLEAN CLAIM
CLAIM ACCEPTED BY A HEALTH PLAN FOR ADJUDICATION
28 terms
chapter 7 Health Insurance Today Edith Watford
Capitation
Closed-panel HMO
consultation
copayment
Common method of reimbursment used primarily by health mainte…
Providers are either HMO employees or belong to a group that…
The process in which professionals work with one another by d…
under managed care health insurance, the specific amount you…
Capitation
Common method of reimbursment used primarily by health mainte…
Closed-panel HMO
Providers are either HMO employees or belong to a group that…
69 terms
Health Insurance Exam: Chapter 7 |Group Accident and Health Insurance
In a group policy the contract is betw…
Master Policy
Evidence of Coverage in a group policy
Certificate of Insurance
Insurance Company, Group Sponsor
The policy name in group insurance, could be the employer, as…
In the form of certificates of insurance, issued to all indiv…
Tells what is covered in the policy, how to file a claim, how…
In a group policy the contract is betw…
Insurance Company, Group Sponsor
Master Policy
The policy name in group insurance, could be the employer, as…
8 terms
Chapter 7: Health Insuring Corporations (HICs)
Health Insuring Corporations (HICs)
HICs rule on limited choice of providers
HICs Gatekeeper policy
Prepaid Basis
provide benefits in the form of services rather than in the f…
only providing care from physicians that meet their standards…
a primary physician needs to refer patient to specialist
HMOs receive flat rate amount each month regardless if you sa…
Health Insuring Corporations (HICs)
provide benefits in the form of services rather than in the f…
HICs rule on limited choice of providers
only providing care from physicians that meet their standards…
Fundamentals of Insurance - Chapter 7
Beneficiary
Cash value
Contingent (secondary) beneficiary
Death benefit
in life insurance, the person or legal entity, such as a char…
the overpayment that accumulates in a life insurance policy
the person or organization who receives the remaining death b…
the sum of money paid to your beneficiary or beneficiaries by…
Beneficiary
in life insurance, the person or legal entity, such as a char…
Cash value
the overpayment that accumulates in a life insurance policy
8 terms
Chapter 7:Insuring your Health and your life
co-insurance
deductible
group plan
health insurance
share of costs for covered insurance services that the insure…
money a policyholder pays prior to insurance company's payment.
insurance plans that cover a large group of individuals,such…
provides payment for med services when ppl suffer a financial…
co-insurance
share of costs for covered insurance services that the insure…
deductible
money a policyholder pays prior to insurance company's payment.
11 terms
Cali. Life, Accident and Health Insurance. **Chapter 7:Annuities
Annuity
The parties of an annuity consist of...
Accumulation Period`
Annuity Period aka annuitization period
A contract that provides income for a specified period of yea…
Owner (purchaser), Annuitant (receiver) and Beneficiary
The time period which owner makes payments (premiums) into an…
Period that sum has been accumulated and then converted into…
Annuity
A contract that provides income for a specified period of yea…
The parties of an annuity consist of...
Owner (purchaser), Annuitant (receiver) and Beneficiary
77 terms
Health Insurance Chapters 7-
Suppose a Medicare HMO had been aggres…
If Medicare HMOs must now provide Medi…
How might an insurer offering coverage…
Demographic characteristics, such as a…
Maybe they would have to target the first four quartiles on e…
If they were very good before at picking who was healthy, and…
Number of visits, utilization used as opposed to health statu…
Prior utlilization
Suppose a Medicare HMO had been aggres…
Maybe they would have to target the first four quartiles on e…
If Medicare HMOs must now provide Medi…
If they were very good before at picking who was healthy, and…
17 terms
CT Life and Health Insurance Exam Chapter 7
$0
Mortality
Employer Salary
Non Occupational
If someone owns an individual disability income policy paying…
Premium determination of disability income policies are based…
A business overhead expense policy provides disability income…
This type of disability income policy excludes losses arising…
$0
If someone owns an individual disability income policy paying…
Mortality
Premium determination of disability income policies are based…
75 terms
Chapter 7: Health Insurance Claim Form (1500 Form)
item number 1;
item number; 1a
item number 2;
item number 3
TYPE OF INSURANCE: Used to indicated type of insurance covera…
INSURED'S ID NUMBER: The insured's id number is the identific…
PATIENT NAME: The patient's name is the name of the person wh…
PATIENT'S BIRTH DATE/SEX: Enter the patient's date of birth i…
item number 1;
TYPE OF INSURANCE: Used to indicated type of insurance covera…
item number; 1a
INSURED'S ID NUMBER: The insured's id number is the identific…
22 terms
Fundamentals of Insurance Chapter 7
OASDHI
Credit
Fully insured
Currently insured
It is the oaks-age, survivors, disability and health insuranc…
It's earned for every $1220 in earnings on which social secur…
Under social security it's either 40 credits or a minimum is…
To meet this a worker having earned at least 6 credits during…
OASDHI
It is the oaks-age, survivors, disability and health insuranc…
Credit
It's earned for every $1220 in earnings on which social secur…
45 terms
Insurance Chapter 7
unearned premium reserve
Unearned premium reserve purpose
loss reserve
case reserves
a liability item that represents the unearned portion of gros…
pay for losses that occur during the policy period; needed so…
large liability on a property/casualty insurer's balance shee…
are loss reserves that are established...
unearned premium reserve
a liability item that represents the unearned portion of gros…
Unearned premium reserve purpose
pay for losses that occur during the policy period; needed so…
63 terms
Insurance and Billing Chapter 7
CPT=What did you do
Current Procedural terminology
E and M Evaluation and management leve…
Most procedures are stand alone
Current Procedural terminology
...
...
...
CPT=What did you do
Current Procedural terminology
Current Procedural terminology
...
68 terms
UNDERSTANDING HEALTH INSURANCE CHAP 7
care plan oversight services
case management services
Category I codes
Category II codes
cover the provider's time supervising a complex and multidisc…
process by which an attending physician coordinates and super…
procedures/services identified by a five-digit CPT code and d…
optional performance measurement tracking codes that are assi…
care plan oversight services
cover the provider's time supervising a complex and multidisc…
case management services
process by which an attending physician coordinates and super…
20 terms
Understanding Health Insurance Final Chapter 6-7
Encounter
Essential modifier
Category III Code
Encoder
Face to face contact between a patient and a health care prov…
qualifies the main term by listing alternative sites, etiolog…
Temporary codes for data collection purpose that are assigned…
Automates the coding process using computerized or web-based…
Encounter
Face to face contact between a patient and a health care prov…
Essential modifier
qualifies the main term by listing alternative sites, etiolog…
59 terms
Insurance Chapter 7
A billing service sending a claim is l…
A claim attachment is additional data…
a claim filing indicator code is an ad…
A claim that does not report at least…
...
...
...
...
A billing service sending a claim is l…
...
A claim attachment is additional data…
...
68 terms
UNDERSTANDING HEALTH INSURANCE CHAP 7
care plan oversight services
case management services
Category I codes
Category II codes
cover the provider's time supervising a complex and multidisc…
process by which an attending physician coordinates and super…
procedures/services identified by a five-digit CPT code and d…
optional performance measurement tracking codes that are assi…
care plan oversight services
cover the provider's time supervising a complex and multidisc…
case management services
process by which an attending physician coordinates and super…
20 terms
Chapter 7 Health
nuclear family
blended family
extended family
affirmation
two parents and one or more children living in the same place
a married couple and their children from previous marriages
a family that includes additional relatives beyond parents an…
positive feedback that helps others feel appreciated and supp…
nuclear family
two parents and one or more children living in the same place
blended family
a married couple and their children from previous marriages
10 terms
Chapter 7 insurance
An estate owner could avoid large esta…
Annuity benefit payments become part o…
If an employer is the ____, he/she may…
What retirement plan was developed pri…
life insurance
benefit payments
beneficiary
HR 10 Plans
An estate owner could avoid large esta…
life insurance
Annuity benefit payments become part o…
benefit payments
35 terms
Health Insurance Ch 7 & 8
Current Procedural Terminology (CPT)
American Medical Association (AMA)
January 1
CPT Codes
a listing of descriptive terms and identifying codes for repo…
first published CPT in 1966, and subsequent editions expanded…
new, revised, and deleted CPT codes must be implemented each
are used to report services and procedures performed on patie…
Current Procedural Terminology (CPT)
a listing of descriptive terms and identifying codes for repo…
American Medical Association (AMA)
first published CPT in 1966, and subsequent editions expanded…
Medical Insurance chapter 7
Database
Clean claim
HIPAA claim
837P claim
Collection of related facts
Claim accepted by a health plan for adjudication
HIPAA-mandated electronic transaction for claims
HIPAA-mandated electronic transaction for claims
Database
Collection of related facts
Clean claim
Claim accepted by a health plan for adjudication
11 terms
CeMap chapter 7 insurance
Types of Term assurance for business
Family income benefit
Convertable TA
Renewable TA
Key person insurance ... Decreasing TA good for repayment mortga…
Pays a annual amount of money if you die within the term, so…
TA can be converted to WOL or END no extra evidence required.
keeps it as TA but no evidence of health needed but preiums i…
Types of Term assurance for business
Key person insurance ... Decreasing TA good for repayment mortga…
Family income benefit
Pays a annual amount of money if you die within the term, so…
59 terms
Chapter 7 Medical Insurance
What legislation required all claims s…
State the name of the health insurance…
Does Medicare accept the CMS-1500 (02-…
What is a pended claim?
ASCA - Administrative Simplification Compliance Act
The CMS - 1500 Claims Form Revised (02-12)
Yes
Held for payment
What legislation required all claims s…
ASCA - Administrative Simplification Compliance Act
State the name of the health insurance…
The CMS - 1500 Claims Form Revised (02-12)
10 terms
chapter 7 insurance
Universal Claim form
Physically clean claim
OCR
Leave the block blank
the health insurance claim form (CMS-1500)
an insurance claim for that contains no staples or highlighte…
Optical character recognition
an OCR CMS-1500 claim form if it does not need any information
Universal Claim form
the health insurance claim form (CMS-1500)
Physically clean claim
an insurance claim for that contains no staples or highlighte…
108 terms
Insurance Chapter 7-10
Accumulation Phase
Annual Reset Method
Annuitant
Annuitization
The Period over which annuity funds are accumulated
The index- linked interest crediting rate is determined each…
The individual upon whose life the contract is dependent. It…
The time when regular periodic payments begin for life or for…
Accumulation Phase
The Period over which annuity funds are accumulated
Annual Reset Method
The index- linked interest crediting rate is determined each…
19 terms
Billing Insurance-Chapter 7
CLEAN CLAIM
INVALID CLAIM
DIRTY CLAIM
DELETED CLAIM
the claim was submitted within the program or policy time lim…
any Medicare claim that contains complete, necessary informat…
a claim submitted with errors, one requiring manual processin…
a claim canceled, deleted, or voided by a Medicare fiscal int…
CLEAN CLAIM
the claim was submitted within the program or policy time lim…
INVALID CLAIM
any Medicare claim that contains complete, necessary informat…
45 terms
Chapter 7: Insurance and Coding
accepting assignment
allowed charge
assignment of benefits
balance billing
the agreement by a healthcare provider who participates in an…
the maximum amount that an insurer will pay for a service or…
the permission given by a policyholder that allows a third-pa…
collecting payment from the insured patient of the difference…
accepting assignment
the agreement by a healthcare provider who participates in an…
allowed charge
the maximum amount that an insurer will pay for a service or…
11 terms
chapter 7 insurance vocabulary
workers compensation insurance
schedule
ergonomics
self-insure
a state method program intended to provide medical and financ…
a list of injuries each with a corresponding dollar value
The science of adapting the workstation to fit the needs of t…
The business assumes the risk on its own and pays the claims
workers compensation insurance
a state method program intended to provide medical and financ…
schedule
a list of injuries each with a corresponding dollar value
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