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Study sets matching "medical insurance chapter 7"

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Study sets matching "medical insurance chapter 7"

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)
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
medical insurance chapter 7
billing provider
carrier block
claim attachment
clean claim
The person or organization (often a clearinghouse or billing…
Data entry area located in the upper right of the CMS-1500 th…
Documentation that a provider sends to a payer in support of…
a claim that is accepted by a health plan for adjudication
billing provider
The person or organization (often a clearinghouse or billing…
carrier block
Data entry area located in the upper right of the CMS-1500 th…
32 terms
MEDICAL INSURANCE CHAPTER 7
HIPAA X12 837 HEALTH CARE CLAIM : PROF…
CMS-1500
CMS-1510*
National Uniform Claim Commitee... (NUCC)
Form used to send a claim for physicain services to primary a…
Paper claim for physician services
The new version
Organization responsible for claim content
HIPAA X12 837 HEALTH CARE CLAIM : PROF…
Form used to send a claim for physicain services to primary a…
CMS-1500
Paper claim for physician services
31 terms
Chapter 7 Medical Insurance
Billing provider
Clean claim
Destination payer
Line item control number
The person or organization sending a HIPAA claim, as distinct…
Claim accepted by a health plan for adjudication
Insurance carrier that is to receive the claim
Unique number assigned by the sender to each service line on…
Billing provider
The person or organization sending a HIPAA claim, as distinct…
Clean claim
Claim accepted by a health plan for adjudication
54 terms
Medical Insurance Chapter 7
billing provider
claim attachment
claim filing indicator code
denied
A billing service sending a claim is likely to be the:
additional data in printed or electronic format
an administrative code used to identify the type of health pl…
A claim that does not report at least one diagnosis code will…
billing provider
A billing service sending a claim is likely to be the:
claim attachment
additional data in printed or electronic format
58 terms
MEDICAL INSURANCE CHAPTER 7
a ____________billing service sending…
a ____________is the additional data i…
a_____________ code is an administrati…
a claim that does not report at least…
billing provider
claim attachment
claim filing indicator
denied
a ____________billing service sending…
billing provider
a ____________is the additional data i…
claim attachment
14 terms
Chapter 7 medical insurance
Medicare A
Medicare B
Medicare C(Medicare advantage plan)
Medicare D
80/20 plan covers in patient services, hospitals, bursing hom…
Covers patient services, home , therapy, physician services ,…
Like a manage care plan, patient pays co payment
Prescription drug plan, all covered drugs are listed in a fol…
Medicare A
80/20 plan covers in patient services, hospitals, bursing hom…
Medicare B
Covers patient services, home , therapy, physician services ,…
32 terms
MEDICAL INSURANCE CHAPTER 7
HIPAA X12 837 HEALTH CARE CLAIM : PROF…
CMS-1500
CMS-1510*
National Uniform Claim Commitee... (NUCC)
Form used to send a claim for physicain services to primary a…
Paper claim for physician services
The new version
Organization responsible for claim content
HIPAA X12 837 HEALTH CARE CLAIM : PROF…
Form used to send a claim for physicain services to primary a…
CMS-1500
Paper claim for physician services
30 terms
medical insurance chapter 7
administrative code set
billing provider
carrier block
claim attachment
Under HIPAA, required codes for various data elements, such a…
The person or organization (often a clearinghouse or billing…
Date entry area located in the upper right of the CMS-1500 th…
Documentation that a provider sends to a payer in support of…
administrative code set
Under HIPAA, required codes for various data elements, such a…
billing provider
The person or organization (often a clearinghouse or billing…
31 terms
Medical Insurance - Chapter 7 - Vocabulary
HIPAA X12 837 Health Care Claim: Profe…
CMS-1500
National Uniform Claim Committee (NUCC)
CMS-1500 (08/05)
form used to send a claim for physician services to primary a…
paper claim for physician services
organization responsible for claim content
current paper claim approved by the NUCC
HIPAA X12 837 Health Care Claim: Profe…
form used to send a claim for physician services to primary a…
CMS-1500
paper claim for physician services
15 terms
Medical Insurance - Chapter 7 - Abbreviations
NUCC
DDE
CLIA
EIN
Naional Uniform Claim Committee
direct data entry
Clinical Laboratory Improvement Amendments
employer identification number
NUCC
Naional Uniform Claim Committee
DDE
direct data entry
30 terms
Insurance in the Medical Office 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.
31 terms
MEDICAL INSURANCE CHAPTER 7 VOCABULARY
5010 VERSION
ADMINISTRATIVE CODE SET
BILLING PROVIDER
CARRIER BLOCK
NEW FORMAT FOR EDI TRANSACTIONS
REQUIRED CODES FOR VARIOUS DATA ELEMENTS
PROVIDER OF HEALTH SERVICES REPORTED ON A CLAIM
DATA ENTRY AREA IN THE UPPER RIGHT PORTION OF THE CMS-1500
5010 VERSION
NEW FORMAT FOR EDI TRANSACTIONS
ADMINISTRATIVE CODE SET
REQUIRED CODES FOR VARIOUS DATA ELEMENTS
82 terms
Chapter 7 : Insurance In The Medical Office.
What does the abbreviation RA stand fo…
What do primary payers issue to detail…
When is it not necessary to submit a c…
What does the abbreviation EMC stand f…
Remittance advice
Remittance Advice
When the payer handles COB
Electronic media claims
What does the abbreviation RA stand fo…
Remittance advice
What do primary payers issue to detail…
Remittance Advice
82 terms
Chapter 7 : Insurance In The Medical Office.
What does the abbreviation RA stand fo…
What do primary payers issue to detail…
When is it not necessary to submit a c…
What does the abbreviation EMC stand f…
Remittance advice
Remittance Advice
When the payer handles COB
Electronic media claims
What does the abbreviation RA stand fo…
Remittance advice
What do primary payers issue to detail…
Remittance Advice
Chapter 7 : Insurance In The Medical Office.
What does the abbreviation RA stand fo…
What do primary payers issue to detail…
When is it not necessary to submit a c…
What does the abbreviation EMC stand f…
Remittance advice
Remittance Advice
When the payer handles COB
Electronic media claims
What does the abbreviation RA stand fo…
Remittance advice
What do primary payers issue to detail…
Remittance Advice
60 terms
Medical Billing, Coding, and Insurance-Chapter 7
HIPAA X12 837 Health Care Claim:Profes…
CMS-1500
National Uniform Claim Committee
CMS-1500 (08/05)
is a form used to send a claim for physician services to prim…
paper claim for physician services.
organization responsible for claim content.
current paper claim approved by the NUCC.
HIPAA X12 837 Health Care Claim:Profes…
is a form used to send a claim for physician services to prim…
CMS-1500
paper claim for physician services.
18 terms
Medical insurance chapter 7 Key terms
American medical Association AMA
Centers for Medicare and Medicaid serv…
Chief complaint CC
Consultation
American Medical Association (AMA) - Professional society tha…
Centers for Medicare and Medicaid services (CMC) - The depart…
Chief complaint (CC) - A concise statement describing the sym…
Consultation - Service by a physician whose opinion or advice…
American medical Association AMA
American Medical Association (AMA) - Professional society tha…
Centers for Medicare and Medicaid serv…
Centers for Medicare and Medicaid services (CMC) - The depart…
60 terms
Medical Billing, Coding, and Insurance-Chapter 7
HIPAA X12 837 Health Care Claim:Profes…
CMS-1500
National Uniform Claim Committee
CMS-1500 (08/05)
is a form used to send a claim for physician services to prim…
paper claim for physician services.
organization responsible for claim content.
current paper claim approved by the NUCC.
HIPAA X12 837 Health Care Claim:Profes…
is a form used to send a claim for physician services to prim…
CMS-1500
paper claim for physician services.
31 terms
Medical Insurance Key Terms Chapter 7
HIPAA X12 837 Health Care Claim: Profe…
CMS-1500
National Uniform Claim Committee
CMS-1500 (08/05)
form used to send a claim for physician services to primary a…
paper claim for physician services
organization responsible for claim content
current paper claim approved by the NUCC
HIPAA X12 837 Health Care Claim: Profe…
form used to send a claim for physician services to primary a…
CMS-1500
paper claim for physician services
Medical Terminology for Insurance and Coding Chapter 7
adenoid/o
agluttin/o
angi/o
ather/o
adenoid
to clump
vessel
fat; fatty plaque
adenoid/o
adenoid
agluttin/o
to clump
60 terms
Medical Billing, Coding, and Insurance-Chapter 7
HIPAA X12 837 Health Care Claim:Profes…
CMS-1500
National Uniform Claim Committee
CMS-1500 (08/05)
is a form used to send a claim for physician services to prim…
paper claim for physician services.
organization responsible for claim content.
current paper claim approved by the NUCC.
HIPAA X12 837 Health Care Claim:Profes…
is a form used to send a claim for physician services to prim…
CMS-1500
paper claim for physician services.
8 terms
Medical Insurance 6E Chapter 7 & 10
A syncopal episode would consist of al…
Grand mal seizures with unconsciousnes…
In which disease are oily areas inters…
Any inflammation of the skin is known…
seizure
...
...
...
A syncopal episode would consist of al…
seizure
Grand mal seizures with unconsciousnes…
...
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…
37 terms
Medical Insurance Chapter 6
Audit
Internal Audit
External Audit
Recovery Audit Contractor - RAC
methodical review
self audit conducted by a staff member or consultant
audit conducted by an outside organization
program designed to audit Medicare claims
Audit
methodical review
Internal Audit
self audit conducted by a staff member or consultant
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
34 terms
Medical Insurance Chapter 13
Determination
Who would establish the medical review…
Who verifies the medical necessity of…
The process of determining whether to…
Payer's decision about the benefits due for a claim
Third-Party Payer
Claims Examiner
Adjudication
Determination
Payer's decision about the benefits due for a claim
Who would establish the medical review…
Third-Party Payer
20 terms
Medical Insurance Chapter 1
NAME THE 10 STEPS OF THE BILLING CYCLE…
What kind of medical services are annu…
The following entities are considered…
What is the name of the program that c…
1 PRE REGISGER PATIENT... 2 ESTABLISH FINANCIAL RESPONSIBILITY... 3…
Preventative Medicine
Nurse practitioners... Long term care facilities... Medical supply…
Medicaid
NAME THE 10 STEPS OF THE BILLING CYCLE…
1 PRE REGISGER PATIENT... 2 ESTABLISH FINANCIAL RESPONSIBILITY... 3…
What kind of medical services are annu…
Preventative Medicine
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…
15 terms
Medical insurance for pharmacy technicians CH 7
Which of the following is a common rea…
The act of comparing the total changes…
Checks that typically indicate that ad…
Checks that are required when the pres…
The patient believes the bill id incorrect, the patient canno…
Account reconciliation and balancing the account
Administrative edits
Safety edits
Which of the following is a common rea…
The patient believes the bill id incorrect, the patient canno…
The act of comparing the total changes…
Account reconciliation and balancing the account
151 terms
Medical Insurance Chapters 4-7
what is ICD
what is ICD-10-CM
what is a code
what is alphabetic index
international classification of diseases
international cclassification of diseases clinical modificati…
a 3-7 character alphanumeric representation of a disease or c…
part of ICD-10-cm listing diseases and injuries alphabeticall…
what is ICD
international classification of diseases
what is ICD-10-CM
international cclassification of diseases clinical modificati…
58 terms
Medical Insurance Chapters 7-9
paper claims are sent on what?
SOF-how long to remain current
billing provider
referring physician
CMS-1500
12 months
billing service sending claim
a pt sent to a physician by another physician
paper claims are sent on what?
CMS-1500
SOF-how long to remain current
12 months
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
...
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…
90 terms
Medical Terminology Chapter 7
balan/o
epididym/o
orchid/o... orchi/o... orch/o... test/o
prostat/o
glans penis
epididymis
testis, testicle
prostate gland
balan/o
glans penis
epididym/o
epididymis
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…
...
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…
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
53 terms
Medical Insurance Chapter one
accounts receivable (A/R)
adjudication
benefits
certificate
Monies owed to a medical practice by its patients and third-p…
The process followed by health plans to examine claims and de…
The amount of money a health plan pays for services covered i…
Term for a Blue Cross and Blue Shield medical insurance policy.
accounts receivable (A/R)
Monies owed to a medical practice by its patients and third-p…
adjudication
The process followed by health plans to examine claims and de…
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…
25 terms
Medical Terminology Chapter 7
heilo-
astr-
-asthenia
fascia
sun
star shaped
weakness
sheet, band
heilo-
sun
astr-
star shaped
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…
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
63 terms
Chapter 7- Insurance
Inpatient 1
Adjuster 1
Claim 1
Premium 1
Bed patient in a hospital
One who acts for the insured or the carrier in a claim.
A request for payment under an insurance contractor bond.
Payment made periodically to keep an insurance policy in force.
Inpatient 1
Bed patient in a hospital
Adjuster 1
One who acts for the insured or the carrier in a claim.
51 terms
Insurance: Chapter 7
Basic Homeowners Coverage
Broad Homeowners Coverage
Perils excluded from most homeowners p…
Open perils coverage
This covers a financial loss to the policyowner's home due to…
This covers a homeowner's loss due to the perils named under…
financial loss caused by: ... earthquake;... flood; ... neglect;... war o…
This increased coverage is designed to protect against all pe…
Basic Homeowners Coverage
This covers a financial loss to the policyowner's home due to…
Broad Homeowners Coverage
This covers a homeowner's loss due to the perils named under…
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…
26 terms
Medical Terminology Chapter 7
What are the two divisions of the nerv…
What does the central nervous system c…
The PNS can be further divided into tw…
Which of the two PNS systems has volun…
1) CNS (central nervous system) 2) PNS (peripheral nervous sy…
brain and spinal cord
1) somatic nervous system 2) autonomic nervous system
somatic nervous system
What are the two divisions of the nerv…
1) CNS (central nervous system) 2) PNS (peripheral nervous sy…
What does the central nervous system c…
brain and spinal cord
25 terms
Insurance Chapter 7/8
Dividends paid by a mutual company are
Dividends are
Mutual company is also known as
Accumulate at Interest Dividend Option
refunds of premium and are not taxable
never guaranteed
a Participating company
results in a taxable even in the year interest is earned
Dividends paid by a mutual company are
refunds of premium and are not taxable
Dividends are
never guaranteed
1 of 10