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Health Insurance
| Question | Answer |
|---|---|
| What does the acronym EFT mean? | Electronic Funds Transfer |
| What does the acronym PAR mean? | Participating Provider |
| What does the acronym ERA mean? | Electronic Remittance Advice |
| What does the acronym COB mean? | Coordination of Benefits |
| What does the acronym EDI mean? | Electronic Data Interchange |
| What is a claim called that contains all required data elements needed to process and pay the claim? | Clean claim |
| What is it called when you submit multiple CPT codes when just one code should have been submitted? | Unbundling |
| What is assigning lower-level codes than documented in the record? | Downcoding |
| What means the provider agrees to accept what the insurance company allows or approves as payment in full for the claim? | Accept Assignment |
| What means that the patient and/or insured authorizes the payer to reimburse the provider directly? | Assignment of Benefits |
| Who is the person responsible for paying the charges for the encouter? | Guarantor |
| Who contracts with a health insurance plan and accepts whatever the plan pays for procedures or services performed? | PAR-Participating Provider |
| What is a provision in group health insurance policies intended to keep multiple insurers from paying benefits covered by other policies? | COB-Coordination of Benefits |
| What in the life cycle of a claim is the transmission of claims data (electronically or manually) to payers or clearinghouses for processing? | Claims submission |
| What in a life cycle of a claim involves sorting claims upon submission to collect and verify information about the patient and provider? | Claims processing |
| What in the life cycle of a claim is the process when the claim is compared to payer edits and the patient's health plan benetits to verify various information? | Claims adjudication |
| What is the financial record source document used by health care providers, in their offices, to record treated diagnoses and services rendered to the patient during the current encounter? | Encounter form or Superbill |
| What is known as thepatient account record in a computerized system, is a permanent record of all financial transactions between the patient and the practice? | Patient Ledger |
| What is a financial record source document used in the hospital? | Chargemaster |
| What is the insurance plan responsible for paying healthcare insurance claims first? | Primary insurance |
| What is a public or private entity that processes or facilitates the processing of nonstandard data elements into standard data elements? | Clearinghouse |
| What is any medical condition that was diagnosed and/or treated within a specified period of time immediately preceding the enrollee's effective date of coverage? | Pre-existing condition |
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copayment. a fixed fee paid by the patient at the time of an office visit. cost sharing. Provision of a healthcare insurance policy that requires policyholders to pay for a portion of their healthcare services; a cost-control mechanism. daysheet. register for recording all daily business transactions. deductible.
Study with Quizlet and memorize flashcards containing terms like The monthly amount an individual pays for a health insurance plan is called a:, The amount an individual must pay annually for healthcare services before the insurance company begins to pay is called a:, An individual visit a doctor for a routine check up. The visit most likely will require the individual to pay a and more.
Learn basics of health insurance assignment with free interactive flashcards. Choose from 500 different sets of basics of health insurance assignment flashcards on Quizlet.
Assignment 1. 1 Insurance Plans 1. For each of the following managed care plans, complete the table and summarized the following types of coverage. Use answers: Yes, No, Depends on plan to fill in the boxes HMO PPO EPO Deductible, copayments, or co-insurance required PCP Required Payment for services outside of provider network Requires referrals
How Health Insurance Works. In this lesson, students will learn about health insurance as a tool to protect both their physical well-being and their financial security. They will also learn key health insurance terminology (e.g., deductible, copayment, coinsurance, and out-of-pocket maximum), the costs and characteristics of various types of ...
What is any medical condition that was diagnosed and/or treated within a specified period of time immediately preceding the enrollee's effective date of coverage? Study free Insurance flashcards about Health Insurance created by YTIMBC to improve your grades. Matching game, word search puzzle, and hangman also available.
WK 1 moa115 medical records and insurance week assignment health records part releasing information and npp directions: answer the following questions. use your. Skip to document. University; High School. Books; ... Week 1 Assignment - Health Records 08-94-21 9. 15-24-24-42-22 10. 24-42-D. Miscellaneous (Answer #1-2)
Assignment 2: Interpret Insurance Card Information. MA116 Module 5 Admin 12021. Directions: Answer the questions, using the insurance cards below. ... FIST HEALTH NETWROK NO YES $30. NO JOHN SAMPLE $1,000- $2, NO 196519M QHU1234567AB MARISA ROYSTON 09/28/ Download. AI Quiz. AI Quiz. Multiple Choice; Flashcards; AI Chat; Download.
Medical Insurance Workbook Chapter 4 Answers Assignment 4.1 Review Questions 1. Insurance contract 2. Guarantor 3. A. Cancelable B. Optionally renewable C. Conditionally renewable D. Guaranteed renewable E. Non-cancelable 4. Indemnity 5. A. Eye glasses/contacts B. Dental treatment 6. 26 7. Precertification 8.
Understanding Health Insurance Workbook Chapter 4 for MIBC Module C Question Answer Assignment 4.1 #2 INSURANCE ELIGIBILITY VERIFICATION Zapp Dawn L ... $150.00 22 $60.00 23 $10.00 24 $74.00 25 (800) 555-6000 Assignment 4.6 2) a. $80.00 2) b. $340.00 4) a. $200.00 4) b. INSURANCE COMPANY Assignment 4.7 2 C 4 C 6 A 8 B 10 C 12 D 14 D 16 C 18 D ...
Study with Quizlet and memorize flashcards containing terms like assignment of benefits, explanation of benefits, health insurance provider and more.
Physical $300 Appendectomy 5,000 Office Visit Total Medical Expenses $5,340 Deductible - 250 $5,090 Stop Loss Point - 1,000 $4,090. 2 teeth cleanings covered at 100% $96 Eye exam covered at 100% $50 New glasses covered at 75% 200 x 0.75 $150. Case #3 Calculation Space: Office Visit $40 Accident 300,000.
Problem 6: Mrs. Smith, a Medicare patient, had surgery, and the participating physician's fee is $1250. This patient is working part-time, and her employer group health plan (primary insurance) allowed $1100, applied $500 to the deductible, and paid 80% of $600. a. Amount paid by this plan: $ 480 b. The spouse's employer group health plan (secondary insurance) is billed for the balance, which ...
Medicare. federal health insurance program for people aged 65 and older, people under age 65 with certain disabilities, and people of all ages with end-stage renal disease (requiring dialysis or a kidney transplant). Medicare Part A. reimburses facilities for inpatient care, skilled nursing care, hospice care, and home healthcare. Medicare part B.
MOA115 Medical Records and Insurance Week 5 Assignment - Reimbursement Concepts. E. Completing the CMS-1500 Health Insurance Claim Form. The medical assistant obtained precertification for a procedure. After the procedure was completed, what are six items needed to complete the CMS-1500 Health Insurance Claim Form? a.
a growing number of uninsured people who are really struggling to pay for out-of-pocket expenses doesn't take a lot of major health events or a serious diagnosis to find yourself with significant bills even with health insurance, difficulties of paying for out-of-pocket costs Cost of health care is so high that even expensive premiums are not enough to cover the full amount without significant ...
a. A federally funded health insurance program for those older than 65 years or disabled individuals younger than 65 years b. A term sometimes applied to private insurance products that supplement Medicare insurance benefits c. A health insurance program that is funded by both the federal and state governments for the medically indigent 2.
1. One of the three largest small group plans in the state, by enrollment. 2. One of the three largest state employee health plans, by enrollment. 3. One of the three largest federal employee health plan options, by enrollment, or. 4. The largest HMO plan offered in the state's commercial market, by enrollment.
Health Insurance with Sherri, Saint Petersburg, Florida. 845 likes · 1 talking about this. Licensed in: AL, AR, AZ, CO, FL, GA, IA, IL, IN, KS, KY, LA,...
Sending it directly to the insurance. Acts as an intermediary between the healthcare facility and the health insurance company. MOA115 Medical Records and Insurance Week 5 Assignment - Reimbursement Concepts. E. Completing the CMS-1500 Health Insurance Claim Form. The medical assistant obtained precertification for a procedure.
is a set of moral values or principles held by individuals or groups. Descriptive ethics. a historical, comparative, or psychological study of the various sets of values that people do in fact have. Evaluative (prescriptive, normative) ethics. a critical enterprise concerning which sets of values people should have. Metaethics.
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Terms in this set (100) What was Mexico's average inflation rate in 2014-2015? 2.5% u000b (Well below 5% since 2000) In what year was Mexico's Ministry of Health created? 1943. What was the major cause of death in Mexico in 2015? Cardiovascular disease. What % of land in Mexico is arable? 13%.