review
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
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| What is a condition that has existed before the insurance policy had been put into effect? | Preexisting condition
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| This type of insurance is established for the spouses and dependents of vets who have total permanent service connected disabilities | CHAMPVA
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| What is the name of the person who is insured or called the policyholder? | subscriber
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| This type of insurance purchased by an individual or family that does not have access to a group health insurance? | Individual insurance
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| This is a specified amount that the insured must pay toward the charge for professional services rendered at the time of service | Copayment
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| This is insurance offered to all employees by the employer | Group insurance
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| This type of insurance was established to aid dependents of active service personnel, retired service personnel and those who died on active duty | TRICARE
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| This is a government insurance program that provides insurance coverage for those who are injured on the job or who have developed work-related disorders, injuries or illness | workers comp
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| What are ICD codes descriptive of? | present a disease or condition
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| If a record is reviewed by a third party payer and a procedure was never documented it means that- | it never happened
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| When must any new, revised or deleted codes must be implemented? | Every January 1st
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| Who publishes the Current Procedural Terminology Manual? | American Medical Association
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| Why is the ICD-9CM manual running out of capacity? | it doesn't allow for the medical advances
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| When are modifiers used? | circumstances for a particular code has been altered
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| Who records the services performed on an encounter form? | physician (provider)
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| Most physicians utilize what volume of the ICD-9 manual? | ONE AND TWO
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| What is the name for the date when the insurance policy goes into effect | Effective date
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| This type of insurance entitles to services provided by participating hospitals, clinics, and physicians | HMO
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| What are the procedures used to ensure no duplication of payment on claims when a pt. has more than one insurance? | Coordination of benefits
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| This is a predetermined amount that the insured must pay each year before the insurance company will pay for an accident or illness | Deductible
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| what is a service area? | Geographic area served by an insurance carrier
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| what is the approval obtained before the pt. is admitted to the hospital or receives specified outpatient or in office procedures called? | Precertification
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| What is the name for a plan that the health care delivery system combines the delivery of health care and payment of services | Managed care
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| What is assignment of benefits? | Authorized by pt. to allow the Dr. to get paid directly from the insurance company
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| This is an insurance plan for the medical care of low income population | Medicaid
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| What is the name of the insurance plan in which the provider gets paid monthly whether the pt. is seen or not? | Capitation
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