Funds ch 17

self-insurance

Large companies, non-profit organizations, and governments frequently use what kind of insurance to reduce costs and gain more control of their finances?

an adjustment

The amount of charges the provider would have to write off if insurance didn't cover it, is known as what?

deductible

The amount of money that the insured must incur for medical services before the policy begins to pay is known as what?

EOB explanation of benefits

The statement mailed to the patient summarizing how the insurance carrier determined the reimbursement is known as what?

patient $12; Medicare $48

Considering the amount that Medicare reimburses for medical care, what amount does the patient and Medicare pay?

regular

Which is the most common type of referral used by managed care? STAT, regular, urgent, post dated

Part B

Which of the following applies to Medicare coverage that pays for outpatient services?

Part D

Which of the following applies to Medicare coverage that pays for prescription drug coverage?

diagnostically related groups

Which of the following applies to a method of containing hospital cost that is based on an average cost for treatment of a patient's condition?

TRICARE

Which of the following applies to medical insurance for dependents of active duty or retired military personnel and their dependents?

receive disability income

Which of the following applies to persons who are eligible for Medicare?

preferred provider organization

Which of the following best describes a network of providers and hospitals who have a contract with insurance companies to provide discounted health care?

traditional

Which of the following best describes insurance policies that provide coverage on a fee-for-service basis?

traditional

Which of the following best describes insurance policies that require policy holders to select a primary care provider?

Medigap

Which of the following best describes policies that are supplementary to Medicare insurance?

point-of-service plan

Which of the following best describes the managed care organization model having the freedom of obtaining medical services from an HMO provider or by self referral to non-HMO provider?

fiscal intermediary

Which of the following best describes the state or regional organization that handles Medicare claims?

worker's compensation

Which of the following is a type of insurance coverage for persons injured on the job?

birthday rule

Which of the following is applied to determine primary coverage for a dependent child when both parents are covered by health insurance?

UCR

Which of the following is known as the fee system that defines allowable charges that will be accepted by insurance carriers? (Usual Customary Reasonable)

CHAMPVA

Which of the following is medical insurance for a spouse and unmarried dependent children of a veteran with permanent total disability resulting from a service-related injury?

post dated

Which of the following is not a category for referrals? post dated, regular, urgent, STAT

coverage, billing

Which of the following is the purpose of screening new patients for insurance coverage? Verify patient has ____ and obtain vital ____ information.

coordination of benefits

Which of the following term is applied when more than one policy covers an individual?

co--insurance

Which of the following terms means an insurance policy pays a percentage of the balance after application of the deductible?

basic

Which of the following traditional type of insurance coverage covers specific dollar amount for provider's fees, hospital care, and surgery?

preauthorization

Before certain procedures or visits can be made, some insurance policies require which of the following?

yes, 80%

Dr. Chad is a participating provider in Medicare. Does this mean Dr. Chad will accept assignment and what percent of the allowed amount?

covers, plan, referral

Each time the patient comes to the clinic,the medical assistant must verify which of the following insurance information? Whether insurance ____ the procedure, what the patient's insurance ____ is, whether a ____ is required.

compensate, cost

Health insurance was designed for what reason? To help individuals and families _____ for high medical ____.

traditional

Indicate whether the statement apply to managed care or traditional insurance plans. Annual deductable

managed care

Indicate whether the statement apply to managed care or traditional insurance plans. Capitation payment

traditional

Indicate whether the statement apply to managed care or traditional insurance plans. Payment fee for service

managed care

Indicate whether the statement apply to managed care or traditional insurance plans. Preventive treatment provided

traditional

Indicate whether the statement apply to managed care or traditional insurance plans. Usually can go outside provider network.

managed care

Indicate whether the statement apply to managed care or traditional insurance plans. Usually must stay inside the provider network

10%

Insurance fraud and abuse may be involved in as many of what percentage of submitted medical claims?