Study sets matching "health insurance chapter 7"

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Study sets matching "health insurance chapter 7"

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.
24 terms
Chapter 7 health insurance
A liability is
What could happen to someone if they d…
what are two ways to obtain health cov…
What is part a for
when you owe someone
Net worth quickly
1. sign up for it 2. company benefit
hospital insurance, recipients receive at no cost.
A liability is
when you owe someone
What could happen to someone if they d…
Net worth quickly
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.
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…
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
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.
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?
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…
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…
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…
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…
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…
374 Chapter 7 Health insurance
Fee-for-service
PPO (preferred provider organization)
HMO (health maintenance organization)
Medicare
-Member (covered individual) pays a premium for a fixed perce…
-Offered by HMO or FFS... -Allows use of providers outside the p…
-Member pays premium... -Fixed copay... -Member must select primary…
-Federal health insurance plan for 65+, and certain disabled…
Fee-for-service
-Member (covered individual) pays a premium for a fixed perce…
PPO (preferred provider organization)
-Offered by HMO or FFS... -Allows use of providers outside the p…
15 terms
Understanding Health Insurance Chapter 7 Key Terms
care plan oversight services
concurrent care
consultation
coordination of care
cover the provider's time supervising a complex and multidisc…
provision of similar services, such as hospital inpatient vis…
examination of patient by a health care provider, usually a s…
provider makes arrangements with other providers or agencies…
care plan oversight services
cover the provider's time supervising a complex and multidisc…
concurrent care
provision of similar services, such as hospital inpatient vis…
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…
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…
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
19 terms
Chapter 7 General Commercial Health Insurance Information Vocabulary
Benefits
Birthday Rule
CMS-1500
Coordination of Benefits
covered services available to an individual or group by a hea…
a coordination of benefits rule that determines the order of…
the claim form used for submitting medical services for payme…
the system that ensures insurance payments do not exceed 100%…
Benefits
covered services available to an individual or group by a hea…
Birthday Rule
a coordination of benefits rule that determines the order of…
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…
Chapter 7: insuring health and life
Health insurance
Medicare
Medicaid
Premium
Provides payments to people who suffer a financial loss as re…
Government health insurance plan that is funded by taxes that…
Government sponsored program that provides health insurance f…
Regular payments in return for insurance coverage
Health insurance
Provides payments to people who suffer a financial loss as re…
Medicare
Government health insurance plan that is funded by taxes that…
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…
Understanding Health Insurance 13th Edition Chapter 7
Care Plan Oversight Services
Case Management Services
Category I Codes
Category II Codes
Cover the provider's time supervising complex and multidiscip…
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 complex and multidiscip…
Case Management Services
Process by which an attending physician coordinates and super…
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: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.
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
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…
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…
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…
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…
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…
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…
6 terms
Insurance - Chapter 7
Pure risk
Speculative risk
Avoidance
Loss prevention
A chance of loss or no loss, but no chance of gain.
A chance of loss, no loss, or gain.
A risk control technique that involves ceasing or never under…
A risk control technique that reduces the frequency of a part…
Pure risk
A chance of loss or no loss, but no chance of gain.
Speculative risk
A chance of loss, no loss, or gain.
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
...
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…
...
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…
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…
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
59 terms
Medical Insurance Chapter 7
A billing service sending a claim is l…
A ______ is additional data in printed…
A ______ code is an administrative cod…
A claim that does not report at least…
billing provider / clearing house
claim attachment
claim filing indicator
denied
A billing service sending a claim is l…
billing provider / clearing house
A ______ is additional data in printed…
claim attachment
Chapter 13; Health Insurance
Assignment of Benefits
Balance Billing
Birthday Rule
Capitation
transfer of the patient's legal right to collect third-party…
billing the patient for the balance or difference between the…
determination of which policyholder's insurance is the first…
managed care plan that pays a certain amount to a provider ov…
Assignment of Benefits
transfer of the patient's legal right to collect third-party…
Balance Billing
billing the patient for the balance or difference between the…
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…
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