Study sets matching "insurance chapter 14"

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Study sets matching "insurance chapter 14"

30 terms
Medical Insurance Chapter 14
What makes a good financial policy?
Some items a Financial policy should c…
Why is it a good idea to collect fees…
What does a day sheet in a medical off…
It is clear to both patients and practice staff
Collection of Co payments, deductibles, past due balances... Cha…
To avoid having to bill patients for unassigned claims
All the transactions that were posted to all patient ledgers…
What makes a good financial policy?
It is clear to both patients and practice staff
Some items a Financial policy should c…
Collection of Co payments, deductibles, past due balances... Cha…
27 terms
Chapter 14- Insurance
Risk
Insurance
Pure Risk
Economic Risk
the possibility of incurring a loss
exchanges the uncertainty of a possible large financial loss…
risk that presents the chance of loss but no opportunity for…
a risk that can result in a financial loss
Risk
the possibility of incurring a loss
Insurance
exchanges the uncertainty of a possible large financial loss…
Chapter 14 insurance
True or False - When advertising, the…
True or False - The premiums for a Buy…
True or False - The health care benefi…
If premiums paid by an employer for a…
False
True
True
Nontaxable
True or False - When advertising, the…
False
True or False - The premiums for a Buy…
True
Medical Insurance Chapter 14
aging
appeal
appellant
autoposting
Classification of accounts receivable by the length of time a…
A request sent to a payer for reconsideration of a claim adju…
One who appeals a claim decision
Software feature that enables automatic entry of payments on…
aging
Classification of accounts receivable by the length of time a…
appeal
A request sent to a payer for reconsideration of a claim adju…
40 terms
Insurance Chapter 14
Financial Policies
Effective Patient Billing
Unpaid Medical Bills
Practice Management Program (PMP)
Is one that both staff members and patients can follow.
Educating patients form the start of the billing and reimburs…
Affect credit scores and the inability to get any sort of loans
uses information to update the day sheet
Financial Policies
Is one that both staff members and patients can follow.
Effective Patient Billing
Educating patients form the start of the billing and reimburs…
19 terms
Car Insurance: Chapter 14
Claim
Bodily injury liability
collision coverage
comprehensive coverage
formal request made to an insurance company for payment for a…
insurance that protects you against financial loss, including…
covers the cost of repairing your car in an accident that is…
insurance that pays for damage to your car caused by somethin…
Claim
formal request made to an insurance company for payment for a…
Bodily injury liability
insurance that protects you against financial loss, including…
12 terms
Chapter 14 - Insurance Premiums and Claims
An Actuary
Factors to consider when calculating t…
A Loading
Methods of reducing price of insurance
the person who calculates the premium for the insurance company
- The amount the item is insured for... - The type of insurance…
An amount added by the insurance company to your insurance pr…
- install a smoke alarm... - install a sprinkler system... - don't…
An Actuary
the person who calculates the premium for the insurance company
Factors to consider when calculating t…
- The amount the item is insured for... - The type of insurance…
20 terms
medical insurance chapter 14
non-sufficient funds check
day sheet
patient statement
cycle billing
check that the bank does not honor because the account lacks…
report summarizing the business day's charges and payments.
document that shows services provided to a patient, total pay…
type of billing that divides patients with current balances i…
non-sufficient funds check
check that the bank does not honor because the account lacks…
day sheet
report summarizing the business day's charges and payments.
36 terms
Medical Insurance - Chapter 14
adjudication
guarantor
claimant
appellant
The process of examining claims and determine benefits
A person who is financially responsible for the bill from the…
Person or entity exercising the right to receive benefits
One who appeals a claim decision
adjudication
The process of examining claims and determine benefits
guarantor
A person who is financially responsible for the bill from the…
15 terms
Chapter 14- Insurance Billing
ACTIVE DUTY SERVICE MEMBER ( ADSM)
BENEFICIARY
URGENT CARE
CHAMPVA
an active member of the United States government military ser…
an individual entitled to receive insurance policy or governm…
medically necessary treatment that is required for illness or…
see the civilian health and medicaid program of the departmen…
ACTIVE DUTY SERVICE MEMBER ( ADSM)
an active member of the United States government military ser…
BENEFICIARY
an individual entitled to receive insurance policy or governm…
15 terms
Chapter 14: Disability Insurance
Short Term Disability Plan
Long Term Disability Plan
Buy Up Plan
Carve Out Plan
Insured or uninsured disability income benefit with a typical…
Income coverage that provides extended benefits after a perso…
Employee beenfit plan under which a covered person can purcha…
Practice of excluding certain classes of employees from benef…
Short Term Disability Plan
Insured or uninsured disability income benefit with a typical…
Long Term Disability Plan
Income coverage that provides extended benefits after a perso…
Chapter 14 Insurance
Liability
Insurance
Policy
Exclusion
Legal responsibility
A contract whereby one party (insurer) agrees to indemnify or…
A proposed or adopted course or principle of action
the process or state of excluding or being excluded.
Liability
Legal responsibility
Insurance
A contract whereby one party (insurer) agrees to indemnify or…
Chapter 14 insurance
liability
insurance
policy
exclusion
A debt; something disadvantageous
A contract under which, for consideration, the insurer, or th…
A plan of action
A rule that provides that otherwise admissible evidence canno…
liability
A debt; something disadvantageous
insurance
A contract under which, for consideration, the insurer, or th…
Chapter 14 Insurance Terms
Policy
Exclusion
Endorsements
Premiums
Written agreement between policy holder and insurance company
Specific risks not covered by the policy
Attachments that either add or take away coverage
Payments you make to insurance company for coverage
Policy
Written agreement between policy holder and insurance company
Exclusion
Specific risks not covered by the policy
27 terms
Medical Insurance Chapter 14
Nonsufficient Funds Check... {NSF}
DaySheet
Patient Statement
Cycle Billing
Check that the bank does not honor because the account lacks…
Report summarizing the business day's charges and payments
Document that shows services provided to a patient, total pay…
Type of billing that divides patients with current balances i…
Nonsufficient Funds Check... {NSF}
Check that the bank does not honor because the account lacks…
DaySheet
Report summarizing the business day's charges and payments
Insurance definitions (chapter 14)
Actuary
How to calculate premium
Compensation
Assessor
The person who calculates the premium for the insurance company
Basic + loadings - reductions = premium
The money paid to you by the insurance company to help you re…
The person sent to inspect the damaged
Actuary
The person who calculates the premium for the insurance company
How to calculate premium
Basic + loadings - reductions = premium
CHAPTER 14 INSURANCE
Liability
Insurance
Policy
Exclusions
Legal responsibility to pay someone who has suffered injury o…
Purchased protection that guarantees to pay you in the event…
Written agreement the policy holders the consumer who purchas…
Risks not covered by policy
Liability
Legal responsibility to pay someone who has suffered injury o…
Insurance
Purchased protection that guarantees to pay you in the event…
Insurance Chapter 14
liability
insurance
policy
exclusion
the state of being responsible for something, especially by l…
a practice or arrangement by which a company or government ag…
a course or principle of action adopted or proposed by a gove…
the process or state of excluding or being excluded
liability
the state of being responsible for something, especially by l…
insurance
a practice or arrangement by which a company or government ag…
Chapter 14 Insurance
Liability
Insurance
Policy
Exclusion
(n.) a debt; something disadvantageous
protection against financial loss
A proposed or adopted course or principle of action
A policy forbidding the admission at trial of illegally seize…
Liability
(n.) a debt; something disadvantageous
Insurance
protection against financial loss
28 terms
Chapter 14: Insurance
liabilty
insurance
policy
exclusion
legal responsibility to pay someone who has suffered an injur…
purchased protection that guarantees to pay you in the case o…
written agreement between the policy holder and the insurance…
specific risks not covered by a policy
liabilty
legal responsibility to pay someone who has suffered an injur…
insurance
purchased protection that guarantees to pay you in the case o…
Chapter 14 Insurance Vocab
Liability
Insurance
Policy
Exclusion
Legal responsibility to pay someone who has suffered an injur…
Purchased protection
A written agreement between the policyholder the consumer and…
A specific risk not covered by a policy
Liability
Legal responsibility to pay someone who has suffered an injur…
Insurance
Purchased protection
Chapter 14 Automobile and Home Insurance
Market value
Policy
Premium
Umbrella policy
The amount an item is worth now
Insurance contract
Regular insurance payment
Provides additional liability protection beyond what is inclu…
Market value
The amount an item is worth now
Policy
Insurance contract
13 terms
chapter 14 insurance
utmost good faith
material misrepresentation
concealment
warrenty
An obligation to act in complete honesty and to disclose all…
A misrepresentation that would effect the insurance company's…
A means of hiding
companies or a sores written agreement to repair a product or…
utmost good faith
An obligation to act in complete honesty and to disclose all…
material misrepresentation
A misrepresentation that would effect the insurance company's…
28 terms
Chapter 14 Insurance
Liability
Insurance
Policy
Exclusion
the state of being responsible for something, especially by l…
a practice or arrangement by which a company or government ag…
a course or principle of action adopted or proposed by a gove…
the process or state of excluding or being excluded.
Liability
the state of being responsible for something, especially by l…
Insurance
a practice or arrangement by which a company or government ag…
40 terms
Insurance Chapter 14
Financial Policies
Effective Patient Billing
Unpaid Medical Bills
Practice Management Program (PMP)
Is one that both staff members and patients can follow.
Educating patients form the start of the billing and reimburs…
Affect credit scores and the inability to get any sort of loans
uses information to update the day sheet
Financial Policies
Is one that both staff members and patients can follow.
Effective Patient Billing
Educating patients form the start of the billing and reimburs…
Insurance chapter 14
Medicare is the __________ single heal…
Medicare is a __________ program autho…
Medicare is administered by __________ .
Medicare is a __________ program that…
largest
federal
CMS
nationwide
Medicare is the __________ single heal…
largest
Medicare is a __________ program autho…
federal
28 terms
Insurance Chapter 14
Accumulation period
Accumulation unit
Annuitant
Annuity
Period prior to retirement when premiums are credited with in…
Purchased by premiums during the period prior to retirement.…
Person who receives the periodic payments or whose life gover…
Periodic payment that continues for a fixed period or for the…
Accumulation period
Period prior to retirement when premiums are credited with in…
Accumulation unit
Purchased by premiums during the period prior to retirement.…
Insurance Chapter 14
Financial Policies
Effective Patient Billing
Unpaid Medical Bills
Practice Management Program (PMP)
Is one that both staff members and patients can follow.
Educating patients form the start of the billing and reimburs…
Affect credit scores and the inability to get any sort of loans
uses information to update the day sheet
Financial Policies
Is one that both staff members and patients can follow.
Effective Patient Billing
Educating patients form the start of the billing and reimburs…
Medical Insurance Chapter 14
Bad debt
Bankruptcy
Collection agency
Collection ratio
An account deemed uncollectible.
Legal declaration that a person is unable to pay his or her d…
Outside firm hired by a practice or facility to collect overd…
The average number of days it takes a practice to convert its…
Bad debt
An account deemed uncollectible.
Bankruptcy
Legal declaration that a person is unable to pay his or her d…
18 terms
Risk and Insurance - Chapter 14
Fixed Annuity
Variable Annuity
Deferred Annuity
Immediate Annuity
Annuity whose periodic payment is a guaranteed fixed amount
Annuity whose periodic payments vary depending on the level o…
Retirement annuity that provides benefit at some future date
Annuity where the first payment is due one payment period fro…
Fixed Annuity
Annuity whose periodic payment is a guaranteed fixed amount
Variable Annuity
Annuity whose periodic payments vary depending on the level o…
45 terms
Insurance Chapter 14- Annuities and IRAs
annuity
annuitant
excessive longevity
Annuity payments consist of three sour…
a periodic payment that continues for a fixed period or for t…
the person who receives the payments from an annuity
when an annuity provides protection against the risk of livin…
premium payments; interest earnings; unliquidated principal o…
annuity
a periodic payment that continues for a fixed period or for t…
annuitant
the person who receives the payments from an annuity
Chapter 14 - Dental Insurance
Integrated Dental Plan
Periodontics - Gum Disease
Stand-alone Plan
Nonscheduled Plan
Dental insurance that is incorporated into a major medical co…
Coverage that may be provided under a dental insurance plan m…
Dental insurance that is marketed by commercial insurance com…
A type of dental plan that provides coverage on a usual, cust…
Integrated Dental Plan
Dental insurance that is incorporated into a major medical co…
Periodontics - Gum Disease
Coverage that may be provided under a dental insurance plan m…
Chapter 14: Insurance
Define insurance
Who pays the premiums?
Who is the insurer?
who has insurable interest?
contract between the parties
the insured
the insurance company
anyone who woulf suffer financial or other loss from the damage
Define insurance
contract between the parties
Who pays the premiums?
the insured
26 terms
insurance chapter 14
What committee maintains UB-04?
What is another name for a hospital pa…
ambulatory care
emergency care
National Uniform Billing Committee
UB-04 or CMS-1450
Another term for outpatient care
involves a situation in which a delay in treatment would lead…
What committee maintains UB-04?
National Uniform Billing Committee
What is another name for a hospital pa…
UB-04 or CMS-1450
18 terms
Insurance Chapter 14
Which type of annuity is comprised of…
Bill's annuity is used to accumulate f…
What is the age based penalty applied…
When do annuity benefits have the leas…
Fixed
Tax qualified
10%
Inflation
Which type of annuity is comprised of…
Fixed
Bill's annuity is used to accumulate f…
Tax qualified
38 terms
Insurance Test: Chapter 14
Medicare
CMS (The center for Medicare and Medic…
4 parts of medicaid
initial enrollment period (Medicare pa…
federal medical expense insurance program for people age 65 a…
division of the united states department of health and human…
part a: Hospital insurance, is financed through a portion of…
when an individual first becomes eligible for medicare (3 mon…
Medicare
federal medical expense insurance program for people age 65 a…
CMS (The center for Medicare and Medic…
division of the united states department of health and human…
19 terms
Chapter 14 -Unemployment Insurance, Disability Insurance, and Workers' Compensation
Unemployment insurance generosity
Krueger (1990, 1991) studied a benefit…
Partial Experience Rating Subsidizes L…
application ... • United States is unus…
Wages do not increase with UI generosity, suggesting UI does…
Every 10% increase in benefits generosity led to a 7% rise in…
o Workers: A temporary layoff is some time off at a partial w…
.60800 42=$20,160... total benefits: 5*20,160=100,800... for te…
Unemployment insurance generosity
Wages do not increase with UI generosity, suggesting UI does…
Krueger (1990, 1991) studied a benefit…
Every 10% increase in benefits generosity led to a 7% rise in…
Chapter 14. Property Insurance
Actual cash value
Deductible
Liability insurance
Package policy
The insured is reimbursed for the replacement cost minus the…
The amount the insured must pay toward a claim before receivi…
Insurance coverage to protect against claims alleging that on…
Insurance coverage for property damage and liability loss in…
Actual cash value
The insured is reimbursed for the replacement cost minus the…
Deductible
The amount the insured must pay toward a claim before receivi…
19 terms
CHAPTER 14 - Property Insurance
Property Insurance
NYSDFS (NYS Department of Financial Se…
Liability Insurance
Package Policy
Protects a home or income/business property against any physi…
Is the regulatory agency that oversees all types of insurance…
Insurance that covers negligence or bodily injury.
An Insurance Policy that includes several types of insurance.
Property Insurance
Protects a home or income/business property against any physi…
NYSDFS (NYS Department of Financial Se…
Is the regulatory agency that oversees all types of insurance…
27 terms
Chapter 14 Health Insurance
claim status codes
aging
appellant
autoposting
used on a HIPAA277 to provide a detailed answer to a claim st…
the classification of accounts receivable by the amount of ti…
the party filing the appeal
Software feature that enables automatic entry of payments on…
claim status codes
used on a HIPAA277 to provide a detailed answer to a claim st…
aging
the classification of accounts receivable by the amount of ti…
17 terms
health insurance chapter 14
medicare
MAC's
Medicare Part A ( No premium)
Medicare Part B (Has premium)
largest single medical benefits program in the united states…
formally called fiscal intermediaries
reimburses institutional providers form (inpatient), hospice…
reimburses providers for (outpatient) services and physicians…
medicare
largest single medical benefits program in the united states…
MAC's
formally called fiscal intermediaries
39 terms
Chapter 14: Health Insurance
advance beneficiary notice (ABN)
allowed amount
assignment of benefits
accept assignment
Document used to notify a Medicare beneficiary that it is eit…
the maximum amount the insurer will pay for any given service
the authorization, by signature of the patient, for payment t…
provider agrees to accept the insurer's payment as payment in…
advance beneficiary notice (ABN)
Document used to notify a Medicare beneficiary that it is eit…
allowed amount
the maximum amount the insurer will pay for any given service
Chapter 14 Health Insurance
Assignment of benefits
Capitation
Co-insurance
Coordination of benefits
The authorizatiom by signature of the patient, for payment to…
Health care provider is paid a fixed amount per member per mo…
The percentage owed by the patient for services rendered afte…
Procedures insured use to avoid duplication of payment on cla…
Assignment of benefits
The authorizatiom by signature of the patient, for payment to…
Capitation
Health care provider is paid a fixed amount per member per mo…
Chapter 14 Key Terms Insurance
Liability
Insurance
Policy
Exclusion
Legal responsibility to pay someone who has suffered an injur…
Purchased protection that guarantees to pay you in the vent o…
Written agreement between the policyholder and the insurance…
Specific risks not covered by a policy
Liability
Legal responsibility to pay someone who has suffered an injur…
Insurance
Purchased protection that guarantees to pay you in the vent o…
19 terms
CHAPTER 14 - Property Insurance
Property Insurance
NYSDFS (NYS Department of Financial Se…
Liability Insurance
Package Policy
Protects a home or income/business property against any physi…
Is the regulatory agency that oversees all types of insurance…
Insurance that covers negligence or bodily injury.
An Insurance Policy that includes several types of insurance.
Property Insurance
Protects a home or income/business property against any physi…
NYSDFS (NYS Department of Financial Se…
Is the regulatory agency that oversees all types of insurance…
21 terms
Dental Insurance Chapter 14
(ADA) American Dental ... Association
Assignment of benefits
Benefits Carrier
Birthday Rule
A professional association for dentists that promotes the int…
Authorization by the enrollee/patient for the dental benefits…
The insurance company, administrator, or other entity that ma…
A method used to determine the order of liability for depende…
(ADA) American Dental ... Association
A professional association for dentists that promotes the int…
Assignment of benefits
Authorization by the enrollee/patient for the dental benefits…
13 terms
Chapter 14 Car Insurance
assigned risk
claim
deductible
insurable interest
a driver who has been assigned an insurance company by the st…
formal request made to an insurance company for payment for a…
the amount you pay for a loss before the insurance company pa…
something of value that, if lost, would cause you financial h…
assigned risk
a driver who has been assigned an insurance company by the st…
claim
formal request made to an insurance company for payment for a…
8 terms
Chapter 14- Social Insurance
Reasons for Socia lnsurance
Survivor benefits on Social Security
Medicare's four parts:
Affordable Care Act on Medicare
1) to help solve complex social problems... 2) to provide covera…
survivor benefits can be paid to dependents of a deceased wor…
PArt A- Hospital Insurance... Part b- Medical Insurance... Part C-…
-Rebates for Part D coverage gap... -Cracking down on health-car…
Reasons for Socia lnsurance
1) to help solve complex social problems... 2) to provide covera…
Survivor benefits on Social Security
survivor benefits can be paid to dependents of a deceased wor…
42 terms
Insurance Chapter 14 Key Terms
Advance Beneficiary Notice (ABN)
Benefit period
Conditional primary payer status
Coordinated care plan
document that acknowledges patient responsibility for payment…
begins with the first day of hospitalization and ends when th…
Medicare claim process that includes the following circumstan…
also called managed care plan; includes health maintenance or…
Advance Beneficiary Notice (ABN)
document that acknowledges patient responsibility for payment…
Benefit period
begins with the first day of hospitalization and ends when th…
21 terms
Chapter 14 Social Insurance
Old-Age, Survivors, and Disability Ins…
Average Indexed Monthly Earnings (AIME)
Primary Insurance Amount (PIA)
Delayed Retirement Credit
Most important Social Insurance program in US. Enacted in 193…
Based on a weighted benefit formula which weighs the benefits…
What monthly retirement benefit is based on
Available if you delay receiving retirement benefits beyond t…
Old-Age, Survivors, and Disability Ins…
Most important Social Insurance program in US. Enacted in 193…
Average Indexed Monthly Earnings (AIME)
Based on a weighted benefit formula which weighs the benefits…
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