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?
