Question | Answer |
a coordination of benifits statement in an insurance policy refers to the waiting period | False |
The effecient medical insurance specialist usually groups together all outstanding charges of patients who have the same type of insurance and processes these insurance claims at the same time | True |
When the insured is required to pay a percentage of the covered service costs, this is referred to as coinsurance | True |
when does the physician/ patient contract begin? | when the doctor accepts the patient and agrees to treat the patient |
MOST PHYSICIANS/PATIENTS CONTRACTS ARE | implied |
WHEN A PATIENT CARRIES PRIVATE MEDICAL INSURANCE, THE CONTRACT FOR TREATMENT EXISTS BETWEEN? | the physician and the patient |
who does the contract exist between in a workers compensation case? | the physician and the insurance company |
in health insurance, the insured is also known as? | the subscriber, member & policyholder |
THE REASON FOR A COORDINATION OF BENIFITS STATEMENT IN A HEALTH INSURANCE POLICY IS | to prevent duplication or overlapping of payments for the same medical expenses |
when a medical facility is sent correct reimbursement from an insurance company for professional services the site recieves? | indemnity, payment and check |
According to the Birthday Law, if both the mom and dad have the same Birthday... | the plan of the person who has coverage is the primary payer |
Conditions that existed and were treated before the health insurancepolicy was issued are called? | preexisting |
An attachment to an insurance policy that excludes certain illnesses or disabilities that would otherwise be covered is referred to as an | waiver |
What is the correct term used to determine if a procedure is covered and medically necessary | Preauthorization |
Mrs Tompsett leaves her place of employment. she is eligible to transfer her medical insurance coverage from a group to an individual contract. This is known as | conversion privilege |
WHY WOULD CONVERSION FROM A GROUP POLICY TO AN INDIVIDUAL POLICY BE ADVANTAGEOUS | no physical examination required |
MR. OTT WAS LAID OFF FROM HIS JOB. HE IS PROTECTED BY COBRA, WHICH REQUIRES HIS EMLOYER TO | extend group health insurance policies for 18 months |
A state and Federal program for children who are younger than 21 years of age and have special health care needs is | Maternal and Child Health Programs (MCHP) |
A PATIENT INTAKE SHEET IS ALSO CALLED | Patient registration form |
An encounter form may also be known as a | patient service slip |
THE SOURCE DOCUMENT FOR INSURANCE CLAIM DATA IS THE | superbill |
A DAILY RECORD SHEET USED TO RECORD DAILY BUSINESS TRANSACTIONS IS CALLED A | Day Sheet |
WHEN THE PHYSICIAN SERVICES HAVE BEEN SUBMITTED TO THE PATIENTS INSURANCE COMPANY BY THE PHYSICIANS OFFICE, THE PATIENT SHOULD | Be sent a monthly statement indicating the insurance company has been billed |
The amount that must be paid each year by the insured before policy benifits begin is known as | deductible |
MANY HEALTH INSURANCE CLAIM FORMS CONTAIN A ___________ OF BENIFITS STATEMENT THAT DIRECTS THE INSURANCE COMPANY TO PAY BENIFITS DIRECTLY TO THE PROVIDER OF CARE ON WHOSE CHARGE THE CLAIM IS BASED | Assignment |
Government sponsered programs that provides hospital and medical services for dependents of active duty. uniformed service members, military retirees and their families, and suvivors of uniformed services. | Tricare |
PROVIDES COVERAGE FOR SPOUSES AND CHILDREN OF VETERANS WITH TOTAL, PERMANENT SERVICE-CONNECTED DISABILITIES OR FOR THE SURVIVING SPOUSES AND CHILDREN OF VETERANS WHO DIED AS A RESULT OF SERVICE-CONNECTED DISABILITIES | CHAMPVA |
A form of health insurance that provides periodic payments to replace income when the insured is unable to work as a result in Illness, injury, or disease. | Disability Income Insurance |
AN ORGANIZATION THAT PROVIDES A WIDE RANGE OF COMPREHENSIVE HEALTH CARE SERVICES FOR A SPECIFIED GROUP AT A FIXED PERIODIC PAYMENT | Health maintence organization (HMO) |
A PROGRAM SPONSERED JOINTLY BY FEDERAL AND STATE GOVERNMENTS FOR MEDICALLY INDIGENT PERSON AGED INDIVIDUALS WHO MEET CERTAIN FINANCIAL REQUIREMENTS AND DISABLED. | Medicaid |
THE HOSPITAL INSURANCE SYSTEM AND SUPPLEMENTARY MEDICAL INSURANCE FOR THOSE OLDER THAN 65 YEARS OF AGE, CREATED BY THE 1965 AMENDMENTS TO THE SOCIAL SECURITY ACT | Medicare |
A contract that insures a person against on-the-job injury or illness | Workers Compensation insurance |