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Study sets matching "medical insurance"

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Study sets matching "medical insurance"

19 terms
Medical Insurance
assignment of benefits
beneficiary
benefit
birthday rule
authorization given by the patient to allow the insurance com…
person who can receive benefits under an insurance plan
payment for a covered service under a health insurance plan
insurance plan of parent whose birthday comes earlier in the…
assignment of benefits
authorization given by the patient to allow the insurance com…
beneficiary
person who can receive benefits under an insurance plan
61 terms
Medical Insurance
Point of Service (POS)
Coinsurance
Mental Health Expenses
National Correcting Coding Initiative…
A plan that permits patients to receive medical services from…
An agreement between the member and the insurance carrier to…
Claims submitted for psychiatric services.
Developed to control improper coding.
Point of Service (POS)
A plan that permits patients to receive medical services from…
Coinsurance
An agreement between the member and the insurance carrier to…
64 terms
Medical Insurance
Point of Service (POS)
Coinsurance
Mental Health Expenses
National Correcting Coding Initiative…
A plan that permits patients to receive medical services from…
An agreement between the member and the insurance carrier to…
Claims submitted for psychiatric services.
Developed to control improper coding.
Point of Service (POS)
A plan that permits patients to receive medical services from…
Coinsurance
An agreement between the member and the insurance carrier to…
83 terms
Medical Insurance Final
List the 10 steps of the Billing Cycle
Why is cash flow important in a medica…
Under an insurance contract who is the…
Under an insurance contract who is the…
1.Preregistration... 2. Establish Financial Responsibility... 3. Ch…
To pay for office expenses
The Patient
The Physician
List the 10 steps of the Billing Cycle
1.Preregistration... 2. Establish Financial Responsibility... 3. Ch…
Why is cash flow important in a medica…
To pay for office expenses
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
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
14 terms
Medical Insurance
mHealth Insurance
Types of Insurance
Medical Care vs Health Care
HEALTH INSURANCE TERMINOLOGY... 1. POLICY…
edi1.Contract that protects insured from loss.... 2.Contract bet…
-Automobile... -Disability... -Liability... -Life... -Malpractice... -Property
Medical Care:... 1. identification of disease... 2.provision of car…
Policyholder... 1. person who signs contract with insurance comp…
mHealth Insurance
edi1.Contract that protects insured from loss.... 2.Contract bet…
Types of Insurance
-Automobile... -Disability... -Liability... -Life... -Malpractice... -Property
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
73 terms
Medical Insurance terms
Accident Insurance
Accidental Death Benefit
Admission
Adult Wellness
A type of insurance enabling the policy holder to get a certa…
A benefit on a life insurance policy that equals the value of…
An inpatient or overnight entry into a hospital, skilled nurs…
Covered services for routine health care screenings and check…
Accident Insurance
A type of insurance enabling the policy holder to get a certa…
Accidental Death Benefit
A benefit on a life insurance policy that equals the value of…
45 terms
Medical Insurance
Point of Service (POS)
Coinsurance
National Correcting Coding Initiative…
Fee Schedule
A plan that permits patients to receive medical services from…
An agreement between the member and the insurance carrier to…
Developed to control improper coding.
List of charges for services provided.
Point of Service (POS)
A plan that permits patients to receive medical services from…
Coinsurance
An agreement between the member and the insurance carrier to…
26 terms
Medical Insurance
HIPAA
HIPAA aspects of concern
PHI
IIHI
Health Insurance Portability and Accountability Act of 1996
- portability of insurance... - patient privacy ... - electronic da…
Protected Health Information
Individually Identifiable Health Information
HIPAA
Health Insurance Portability and Accountability Act of 1996
HIPAA aspects of concern
- portability of insurance... - patient privacy ... - electronic da…
15 terms
Medical insurance
Provider
Benefits
Carrier
Guarantor
Another name for the physician or other non-physician practit…
Payments made by the insurance company
Another name for insurance company
The one responsible for the account (guarantees to pay the bi…
Provider
Another name for the physician or other non-physician practit…
Benefits
Payments made by the insurance company
25 terms
Medical Insurance, and Medical Office
Point-of-Service
Benefit Period
Medicare A
Medicare B
allows beneficiaries to choose a provider that is or is not w…
A specified time during which benefits will be paid under cer…
benefits covering inpatient hospital and skilled nursing faci…
benefits covering outpatient hospital and health care provide…
Point-of-Service
allows beneficiaries to choose a provider that is or is not w…
Benefit Period
A specified time during which benefits will be paid under cer…
37 terms
medical insurance
accept assignments
acknowledgment of receipt of notice of…
assignment of benefits
birthday rule
participating physicians agreement to accept allowed charge a…
form accompanying a covered entitys Notice of privacy practic…
authorization allowing benefits to be paid directly to a prov…
guideline that determines which parent has the primary insura…
accept assignments
participating physicians agreement to accept allowed charge a…
acknowledgment of receipt of notice of…
form accompanying a covered entitys Notice of privacy practic…
37 terms
Medical Insurance / Types of Insurance
Premium
Rider
Customary Fee
Fee Schedule
A specific sum of money paid by the insured to the insurance…
an add-on to an insurance policy
The range of fees charged by most physicians in the community…
The price list for the medical practice, which lists the serv…
Premium
A specific sum of money paid by the insured to the insurance…
Rider
an add-on to an insurance policy
45 terms
Medical Insurance
Insurance
Premium
Insurer
Indemnity
Act/business, through legal means of protecting an individual…
Payment for legal protect periodically paid
The insuring party
Reimburse
Insurance
Act/business, through legal means of protecting an individual…
Premium
Payment for legal protect periodically paid
9 terms
Medical insurance
Insurance coverage through employer
HMO
PPO
Agency plan
-Eligibility=continuous employment - 20 hrs a week - companie…
Type of managed care - specialized treatment is available wit…
Can choose from a list of providers - pay a co-payment - refe…
Patients may pay for more care - may have large deductibles -…
Insurance coverage through employer
-Eligibility=continuous employment - 20 hrs a week - companie…
HMO
Type of managed care - specialized treatment is available wit…
20 terms
Medical Insurance
Notify a supervisor of the accident
Permanent and stationary
benefit cap
financial means test
the first step an employee should take for a first report of…
the condition in which the employee has reached a state of ma…
a maximum benefit amount paid for short-term disability polic…
a detailed and comprehensive questionaire that establishes fi…
Notify a supervisor of the accident
the first step an employee should take for a first report of…
Permanent and stationary
the condition in which the employee has reached a state of ma…
90 terms
Medical Insurance
Capitation
Network Provider
Deductible
NCQA (National Committee for Quality A…
When providers accept pre-established payments for providing…
A physician or health care facility under contracts to the ma…
Amount of money subscribers must pay before plan benefits are…
One of two organizations that evaluate and accredit managed c…
Capitation
When providers accept pre-established payments for providing…
Network Provider
A physician or health care facility under contracts to the ma…
30 terms
Medical insurance \ medical insurance coding
Adjustment
Assignment of benefits
Beneficiary
Coordination of benefits cob
Increases or decreases to patient accounts not due to charges…
Signing over benefits by the beneficiary to another party
Person under a policy eligible to receive benefits
The provision of an insurance contract that limits benefits t…
Adjustment
Increases or decreases to patient accounts not due to charges…
Assignment of benefits
Signing over benefits by the beneficiary to another party
40 terms
Medical insurance
What is the WHO?
The _____is used for submitting Medica…
What tyoe of plan is a benefit for dep…
What is CPT? Who developed it? Why?
World health organization. Developed by ICD
CMS1500
Civilian Health and Medical Program-Uniform Services CHAMPUS/…
Current procedural terminology/ American Medical Association/…
What is the WHO?
World health organization. Developed by ICD
The _____is used for submitting Medica…
CMS1500
49 terms
MEDICAL INSURANCE
PPACA
HIPAA
CONCERNS OF HIPAA
HEALTH INSURANCE CLAIM
PATIENT PROTECTION AFFORDABILITY CARE ACT
HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
1.Portability of insurance... 2.patient privacy... 3.eletronic tr…
document submitted to the payer requesting reimbursement
PPACA
PATIENT PROTECTION AFFORDABILITY CARE ACT
HIPAA
HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
25 terms
Medical Insurance, and Medical Office
Point-of-Service
Benefit Period
Medicare A
Medicare B
allows beneficiaries to choose a provider that is or is not w…
A specified time during which benefits will be paid under cer…
benefits covering inpatient hospital and skilled nursing faci…
benefits covering outpatient hospital and health care provide…
Point-of-Service
allows beneficiaries to choose a provider that is or is not w…
Benefit Period
A specified time during which benefits will be paid under cer…
73 terms
Medical Insurance
Determine which method a self-funded h…
Choose the entity(ies) that may form a…
The titles of Certified Coding Special…
If a cross reference appears after a m…
buy the use of existing networks from managed care organizati…
the patient and provider
AHIMA
must look up the term that follows the word see in the inde
Determine which method a self-funded h…
buy the use of existing networks from managed care organizati…
Choose the entity(ies) that may form a…
the patient and provider
21 terms
Medical insurance
FSA
HSA
HRA
HMO
(FLEXIBLE SPENDING ACCOUNT) AN FSA OFTEN SET UP THROUGH AN EN…
(HEALTHSAVING ACCOUNT) AN ACCOUNTTAT LETS OU SAVE FORTHE FUTU…
HEALTH REIMBURSEMENT ACCOUNT) AN ACCOUNT THAT LETS AN EMPLOYE…
HEALTH MAINTENANCE ORGANIZATION) OFFERS HEALTHCARE SERVICES O…
FSA
(FLEXIBLE SPENDING ACCOUNT) AN FSA OFTEN SET UP THROUGH AN EN…
HSA
(HEALTHSAVING ACCOUNT) AN ACCOUNTTAT LETS OU SAVE FORTHE FUTU…
26 terms
Medical Insurance/Medical Insurance Coding
Adjustment
Assignment of Benefits
Beneficiary
Coordination of Benefits (COB)
Increases/decreases to patient accounts not due to charges in…
Signing over of benefits by the beneficiary to another party
Person under a policy eligible to receive benefits
Provision of an insurance contract that limits benefits to 10…
Adjustment
Increases/decreases to patient accounts not due to charges in…
Assignment of Benefits
Signing over of benefits by the beneficiary to another party
32 terms
Intro to Medical Insurance
Medicare
Medicaid
TRICARE
premium
The government health insurance program for the elderly, the…
The government health insurance program for low-income indivi…
The government health insurance program for dependent spouses…
The amount of money paid by the consumer to purchase health i…
Medicare
The government health insurance program for the elderly, the…
Medicaid
The government health insurance program for low-income indivi…
59 terms
Medical Insurance
Point of Service (POS)
Coinsurance
Mental Health Expenses
National Correcting Coding Initiative…
A plan that permits patients to receive medical services from…
An agreement between the member and the insurance carrier to…
Claims submitted for psychiatric services.
Developed to control improper coding.
Point of Service (POS)
A plan that permits patients to receive medical services from…
Coinsurance
An agreement between the member and the insurance carrier to…
28 terms
Medical Insurance/ Medical Insurance Coding
Adjustment
Assignment of benefits
Beneficiary
Coordinator of benefits (COB)
increases or decreases to patient accounts not due to charges…
signing over of benefits by the beneficiary to another party
person under a policy eligible to receive benefits
the provision of an insurance contract that limits benefits t…
Adjustment
increases or decreases to patient accounts not due to charges…
Assignment of benefits
signing over of benefits by the beneficiary to another party
24 terms
Medical Insurance
Managed care organizations were establ…
The MCO can be a health care plan, hos…
Outpatient expenses such as physical t…
Which of the following is true about a…
b. curb medical costs
c. provider group
b. Medicare Part B
d. The final total benefit is not greater than the original c…
Managed care organizations were establ…
b. curb medical costs
The MCO can be a health care plan, hos…
c. provider group
9 terms
Medical insurance
Health care provider
Premiums
Claim
ID Card
Doctor
Payments
Request
Credential
Health care provider
Doctor
Premiums
Payments
Medical insurance
Health insurance plan
Pre-existing condition
Guaranteed issue
Diagnostic related groups (DRG's)
A plan that helps consumer pay for some (not all) medical cost
Illness present when acquiring new insurance
Law-all people must be insured
Insurance pays set amount for procedure, despite actual cost
Health insurance plan
A plan that helps consumer pay for some (not all) medical cost
Pre-existing condition
Illness present when acquiring new insurance
25 terms
Medical insurance
Understanding the role of medical insu…
Terminology specific to insurance poli…
Traditional insurance
Blue cross and blue shield
Medical care consists of:... -diagnosis of diseases/disorders... -c…
Beneficiary... Deductible... Coinsurance... Co-payment... Health maintena…
Fee for service basis... Types of coverage... Basic insurance... Major…
Function independently in their own area... Organized as not for…
Understanding the role of medical insu…
Medical care consists of:... -diagnosis of diseases/disorders... -c…
Terminology specific to insurance poli…
Beneficiary... Deductible... Coinsurance... Co-payment... Health maintena…
20 terms
Medical Insurance
HMO - Health Maintenance Organization
Indemnity
PPO - perferred provider organization
major medical
an association that provides all care to the insured person f…
plan through which the insurance person selects his or her ow…
list of providers, hospitals, and other health care services…
type of insurance that does not cover primary care, but cover…
HMO - Health Maintenance Organization
an association that provides all care to the insured person f…
Indemnity
plan through which the insurance person selects his or her ow…
11 terms
Medical Insurance
HMO (Health Maintenance Organization)
PPO (Preferred Provider Organization)
Medicare
Medicaid
a type of managed care medical insurance where specialist tre…
physicians contract services for a set fee and are listed as…
government program providing health care to people over age o…
medical assistance program that is operated by the state, not…
HMO (Health Maintenance Organization)
a type of managed care medical insurance where specialist tre…
PPO (Preferred Provider Organization)
physicians contract services for a set fee and are listed as…
30 terms
Medical Insurance
Premium
Explanation of benefits (EOB)
Beneficiary
Deductible
A specific sum of money paid by the insured to the insurance…
A recap sheet that accompanies a Medicare or Medicaid check,…
Someone who receives money if an insured person dies
Specified amount of money that the insured must pay for cover…
Premium
A specific sum of money paid by the insured to the insurance…
Explanation of benefits (EOB)
A recap sheet that accompanies a Medicare or Medicaid check,…
10 terms
Medical insurance
CMS
Coding
Embezzled
Ethics
The administrative agency withing the federal department
The process of assigning codes to procedures and services
The illegal transfer of money or property as fraudulent act
Good behavior and conduct
CMS
The administrative agency withing the federal department
Coding
The process of assigning codes to procedures and services
22 terms
Medical Insurance
bed patient in a hospital is called __…
one who acts for the insured of the ca…
a request for payment under an insuran…
payment made periodically to keep an i…
inpatient
adjuster
claim
premium
bed patient in a hospital is called __…
inpatient
one who acts for the insured of the ca…
adjuster
21 terms
Medical Insurance
Health maintenance organization (HMO)
Indemnity plan
Preferred provider organization (PPO)
Major medical
An association that provides all care to the insured person f…
Plan through which the insured person selects his or her own…
a list of physicians, hospitals, and other health care servic…
type of insurance that does not cover primary care, but cover…
Health maintenance organization (HMO)
An association that provides all care to the insured person f…
Indemnity plan
Plan through which the insured person selects his or her own…
24 terms
MEDICAL INSURANCE
MEDICAL INSURANCE
MEDICAL BILLING
Rider
carve out
ENGLISH
ENGLISH
Document modifying an insurance contract
part of a standard health plan changed under an employer-spon…
MEDICAL INSURANCE
ENGLISH
MEDICAL BILLING
ENGLISH
20 terms
Medical Insurance
Exclusion
Beneficiary
Coinsurance
Adjustment
This time-dependent limitation of coverage. (pg. 377)
A policy an agreement between an insurance company or governm…
Percentage (pg. 377)
The amount the provider would have to write off (pg.390)
Exclusion
This time-dependent limitation of coverage. (pg. 377)
Beneficiary
A policy an agreement between an insurance company or governm…
29 terms
Medical Insurance
Co-Insurance
Coordination of Benefits
Birthday Rule
Explanation of Benefits
Percentage of cost of the services paid by the insurance carr…
When a person has two or more insurances, the insurances coor…
Method to determine which parent's policy will cover a depend…
Insurance report that is sent with claim payments explaining…
Co-Insurance
Percentage of cost of the services paid by the insurance carr…
Coordination of Benefits
When a person has two or more insurances, the insurances coor…
22 terms
Medical insurance
abuse
adjudicated
balance billing
categorically needy
payments for items or services in which there was no intent t…
how the payment was determined
billing the recipient for any amount not paid by Medicaid
classification of individuals who fall into a specific catego…
abuse
payments for items or services in which there was no intent t…
adjudicated
how the payment was determined
18 terms
Medical Insurance
AMA
AMIHMA
ACA
HIPPA
American Medical Association
American Health Information Management Association
American Collectors Association
Health Insurance Portability and Accountability
AMA
American Medical Association
AMIHMA
American Health Information Management Association
27 terms
medical insurance
pip
comprehension coveragee
collision coverage
liabality coverage
and extension of care insurance
protects you againist vechile damage
pay when yuor vechile get danaged
pretects the insured when they are sued
pip
and extension of care insurance
comprehension coveragee
protects you againist vechile damage
23 terms
Medical Insurance
self funded plan
waiting period
ERISA ( Employee Retirement Income Sec…
late enrolleee
an organization that assumes the risk of paying for health in…
amount of time that must pass before an employee/dependent ma…
law providing incentives and protection for companies with em…
category of enrollment that may have different eligibility re…
self funded plan
an organization that assumes the risk of paying for health in…
waiting period
amount of time that must pass before an employee/dependent ma…
24 terms
Medical Insurance
Correct Claims
To keep updated on changes in third pa…
CCI
Claims are often denied
Report the connection between a billed serviceand a diagnosis
Medical insurance specialists rely on payer bullentins, websi…
Controls improper coding that would lead to inappropriate pay…
For lack of medical necessity when the reported services are…
Correct Claims
Report the connection between a billed serviceand a diagnosis
To keep updated on changes in third pa…
Medical insurance specialists rely on payer bullentins, websi…
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…
52 terms
Medical Insurance
NPI
NPP
PHI
EMR
National provider identifier... -unique 10 digit identifier assi…
Notice of privacy practices... -mandated description of a covere…
Protected health information... -individual identifiable health…
emergency medical record... -single record of patients records
NPI
National provider identifier... -unique 10 digit identifier assi…
NPP
Notice of privacy practices... -mandated description of a covere…
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