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…
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
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…
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
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…
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
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
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…
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
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
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…
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…
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
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
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
Medical insurance
Verification of benefits (VOB)
Premium
Fee schedule
Allowed amount
Process of determining patients eligibility to see if they ar…
Policyholders pays this to the insurance carrier
(Fill in) lists the charge for each services provided
What insurance companies consider be to an appropriate fee
Verification of benefits (VOB)
Process of determining patients eligibility to see if they ar…
Premium
Policyholders pays this to the insurance carrier
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
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…
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…
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…
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
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…
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
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…
47 terms
Medical insurance chapter 8
Administrative services only (ASO)
Blue card
BlueCross BkueShield Association (BCBS)
Carve out
Contract under which a third party administrator or insurer p…
program that provides benefits for subscribers who are away f…
National health care licensing association
Part of a standard health plan changed under an employer-spon…
Administrative services only (ASO)
Contract under which a third party administrator or insurer p…
Blue card
program that provides benefits for subscribers who are away f…
medical insurance billing and coding
english
billing codes
cpt codes
medical insurance
...
icd 10
cpt 9
health insurance today
english
...
billing codes
icd 10
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
25 terms
Chapter 3 Medical Insurance
An established patient is defined as o…
You are working in a practice and a pa…
Identify the best time during which to…
Which of these documents will the pati…
three years
review and update the information that is on file about them
preregistration process
encounter form
An established patient is defined as o…
three years
You are working in a practice and a pa…
review and update the information that is on file about them
37 terms
Chapter 2 Medical Insurance
Which of the following laws is designe…
A Notice of Privacy Practices is given…
Patients' PHI may be released without…
Which government group has the authori…
HIPAA
A practice's patients
employers in workers' compensation cases
OCR
Which of the following laws is designe…
HIPAA
A Notice of Privacy Practices is given…
A practice's patients
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…
Medical Insurance-Types of Insurance
Basic Medical
Disability Protection
Liability Insurance
Major Medical
Pay a large part of hospital and medical care, may also pay p…
Covers loss of income that results from illness. It is not to…
Insurance that provides protection from claims arising from i…
Health insurance policy designed to offset heavy medical expe…
Basic Medical
Pay a large part of hospital and medical care, may also pay p…
Disability Protection
Covers loss of income that results from illness. It is not to…
Medical insurance
Health Insurance
Types of Insurance
Medical Care vs Health Care
HEALTH INSURANCE TERMINOLOGY... 1. POLICY…
1.Contract that protects insured from loss.... 2.Contract betwee…
-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…
Health Insurance
1.Contract that protects insured from loss.... 2.Contract betwee…
Types of Insurance
-Automobile... -Disability... -Liability... -Life... -Malpractice... -Property
Medical insurance
Cash flow
Accounts receivable... AR
Accounts payable... AP
RCM ... REVENUE MEDICAL CYCLE
Movement of monies in and out of a business
Adding money to the business
Taking money to pay expenses for business
Acting to ensure practice receives managing revenue as postiv…
Cash flow
Movement of monies in and out of a business
Accounts receivable... AR
Adding money to the business
Medical Insurance
Advanced Beneficiary Notice of Noncove…
Assignment of benefits
Beneficiary
Birthday rule
Notification to the beneficiary (insured by Medicare) of thei…
Authorization for the insurance company to send insurance pay…
A person eligible to receive insurance benefits
A method used to determine the primary insurance carrier when…
Advanced Beneficiary Notice of Noncove…
Notification to the beneficiary (insured by Medicare) of thei…
Assignment of benefits
Authorization for the insurance company to send insurance pay…
87 terms
Medical Insurance
Accept Assignment
Accounts Receivable
Accounts Receivable Aging Report
Accounts Receivable Management
...
...
...
...
Accept Assignment
...
Accounts Receivable
...
Medical Insurance
Health Insurance claim-
Healthcare provider-
Claims examiner-
Independent contractor-
Documentation submitted to a 3rd party payer requesting reimb…
Physican or other healthcare practitioner
Reviews health related claims, to determine if changes are re…
Performs services for another under an agreement
Health Insurance claim-
Documentation submitted to a 3rd party payer requesting reimb…
Healthcare provider-
Physican or other healthcare practitioner
Medical Insurance
Fraud
Abuse
Embezzlement
Cash flow
When an individual knowingly, willingly and intentionally sub…
Incidents or practices by physicians, not usually considered…
Stealing money that has been entrusted in one's care.
the mount of actual money generated and available for use by…
Fraud
When an individual knowingly, willingly and intentionally sub…
Abuse
Incidents or practices by physicians, not usually considered…
Medical insurance
Medical assistant
Cash flow
Accounts receivable
Account payable
Administrative medical employee
Movement of monies into or out of a business
Monies owed to a medical practice
Practices operating expenses
Medical assistant
Administrative medical employee
Cash flow
Movement of monies into or out of a business
Medical Insurance
HIPAA
POR
SOAP
CPT
Health Insurance Probability And Accountability Act of 1996
Problem Oriented Record
Subjective, Objective, Assessment and Plan
Common Procedural Technology
HIPAA
Health Insurance Probability And Accountability Act of 1996
POR
Problem Oriented Record
Medical Insurance
Premium
UCR
Assignment of Benefits
Utilization review
Amount charged for a medical insurance policy. The insurer ag…
The usual, customary, and reasonable fee. It is determined by…
An authorization to an insurance company to make payment dire…
Examination of services by an outside group. A utilization re…
Premium
Amount charged for a medical insurance policy. The insurer ag…
UCR
The usual, customary, and reasonable fee. It is determined by…
Medical.insurance
Coord of benefits
Medicare
Medicaid
Champva
Rules followed by insurance companies so that no man is reimb…
For elderly people
Low income individuals
Covered dependent spouses and children of military veterans
Coord of benefits
Rules followed by insurance companies so that no man is reimb…
Medicare
For elderly people
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…
13 terms
Medical insurance
A partir de
Seguros médicos
El cual
A través de
Starting in (date)
Medical insurance
Which
Through
A partir de
Starting in (date)
Seguros médicos
Medical insurance
35 terms
Medical Insurance
assignment of benefits
authorization
beneficiary
birthday rule
Authorization for insurance reimbursement to be made to the p…
official permission
a person who can receive benefits under an insurance plan
the rule that determines which insurance is primary for the c…
assignment of benefits
Authorization for insurance reimbursement to be made to the p…
authorization
official permission
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