When a patient gives written authorization for reimbursement to the physician for billed charges this is called
A. Coordination of benefits
B. Capitation
C. Assignment of benefits
D. Copayment
Coordination of benefits means
A. The patient pays a specific amount of money for medical services before the insurance pays
B. One insurance plan will work with other insurance plans to determine how much each plan pays
C. There is a flat fee paid for each service
D. There is a deduct
The person who is covered by a benefits plan is the
A. Employee
B. carrier
C. Administrator
D. Insured
A person's spouse or child who is covered under the benefits plan is called the
A. Group Member
B. Coinsured
C. Primary Carrier
D. Carrier
E. Dependent
The amount that will be paid by the insurance plan for each procedure or service is based on the
A. Coinsurance
B. Capitation
C. Deductible
D. Fee schedule
A government-sponsored program that provies health benefits to low income or indigent
A. CHAMPUS
B. CHAMPVA.
C. Medicare
D. Medicaid
E Blue Cross and Blue Shield
Expenses resulting from work related illness or injury are usually covered by
A. Medicare
B. HMO's
C. Workers Compensation
D. Employee's Health Insurance
That statement issued to the provider and the patient that lists the details of a payment that has been made by the insurance plan is the
A. Fee Schedule
B. Corrdination of benefits
C. Assignment of benefits
D. Explanation of benefits
E. Deductible
If a patient is diagnosed with a disease before the effective date of the insurance plan it is a
A. Preexisting Condition
B. Crossover claim
C. exclusion
D. Capitation
The amount of eligible charges each patient must pay each calendar year before the plan begins to pay benefits is called
A. Coinsurance
B. Exclusion
C. Eligibility
D. Capitation
E. Deductible
Medicare is a federal health insurance program for
A. Anyone over 62 years of age
B. Disabled workers who are at least 65 years of age
C. Blind individuals who are at least 50 years of age
D. Individuals 65 years of age or older who are retired and on social security
Medicare Part A provides coverage for
A. Clinical laboratory services
B. Physician's office services
C. Hospitalization
D. Physician's hospital services
E. Outpatient referral fee for a specialist
The process of determining whether a service or procedure is covered by the insurance provider is called
A. Coordination of benefits
B. Precertification
C. Capitation
D. Assignment of Benefits
The medical bills of spouses and children of veterans with total, permanent service-connected disabilities are covered under
A. Blue Cross
B. HMO
C. Workers Compensation
D. HCFA
E. Champva
The process of making a payment to a provider based on a fixed amount per enrollee assigned to that provider regardless of services provided is
A. Exclusion
B. Deductible
C. Capitation
D. Predetermination
A group of physicians who review cases for appropriateness of hospitalization and discharges is called
A. relative value studies
B. Preferred Provider organization
C. Quality improvement organization
D. Third-Party Payer
E. State medical board
A health maintenance organization is best described as
A. A group of physicians who have a contract to provide services to participating patients for a predetermined fee
B. Independently practicing physicians providing services to patients covered under all types of insurance
C. A group of physicians who are
A database or list of charges for each procedure indicating the charge of the majority of physicians in a geographic area is referred to as
A. Utilization review
B. Usual, customary, and reasonable
C. Coordination of benefits
D. Explanation of benefits
E. Capitation
Medicare Part B does not cover
A. Physician office visits
B. Diagnostic laboratory services
C. Hospitalization
D. Outpatient X-rays
Health benefits policies are purchased by an individual by paying the
A. Premium
B. Deductible
C. Copayment
D. Coinsurance
E. Exclusion
A primary care physician or PCP is
A. Only authorized to accept assignment of benefits
B. A specialist who accepts referral patients Medicare patients
C. Not authorized to accept medicare patients
D. A general practitioner who oversees patients in an HMO or PPO
A condition or circumstance for which the health insurance policy will not provide benefits is a
A. Benefits
B. Exclusion
C. Review
D. Waiting Period
E. Capitation
Insurance coverage that provides a specific monthly or weekly income when an indivdiual becomes unable to work because of an illness or injury is
A. Workers compensation insurance
B. Disability income insurance
C. TRICARE insurance
D. Major medical insurance
The amount of money owed by the insured to the provider at the time of service is called
A. Capitation
B. Exclusive
C. Fee-for-service
D. Indemnity
E. Copayment
When a dependent child is covered by the benefit plans of both parents determination of the primary carrier is based on the
A. Coordination of benefits
B. Coinsurance
C. Assignment of benefits
D. Birthday rule
In order to be eligible for Medicare Part C the participant must be enrolled in
A. Medicare Part B and Medicare Part D
B. An HMO Plan
C. Medicare part A and Medicare Part B
D. Medicaid
E. Medigap
The medicare part specifically designed to provide pharaceutical coverage is
A. Part A
B. Part B
C. Part C
D. Part D
A hospital payment system that categorizes Patient by diagnosis and treatment is referred to as
A. ICD
B. CPT
C. UCR
D. HCPCS
E. DRG
UCR provider payments are based on
A. What the majority of physicians in a specific geographic area charge for procedures
B. State laws where the physician practices medicine
C. The maximum amount paid by other insurance companies for similar procedures
D. Recommendations of the federal go
When a medicare patient is told that he or she may be responsible for payment of services not covered by medicare, the physician's office should inform the patient and have the patient sign a form called a
A. EOB
B. HMO
C. ABN
D. DRG
E. CPT