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Health Insurance - 1
ACI - Medical Billing and Coding
| Question | Answer |
|---|---|
| Money leftover | Profit |
| Medical Record | Legal document of patient assessment |
| 1st Party | Patient |
| 2n Party | Provider |
| 3rd Parth | Health Insurance Co. |
| Name the two types of health insurance | Government and Private |
| Define each letter of S.O.A.P. | S - Subjective, O - Objective, A - Assessment, P - Plan of treatment |
| In S.O.A.P., give a brief description of "S" | "S" is subjective data, data that is not measurable such as "I have a bad cough", "I am in a lot of pain." |
| In S.O.A.P., give a brief description of "O" | "O" is objective data, data that is measurable such as a blood pressure, temperature, etc. reading. Pain expressed as a number from 1-10. |
| In S.O.A.P., give a brief description of "A" | "A" is the healthcare provider's assessment of the patient such as hypertension, sprain. |
| In S.O.A.P., give a brief description of "P" | "P" is the plan of treatment that the healthcare provider has set for the patient. |
| What is E.O.B.? | Explanation of benefits |
| What is E.O.M.B.? | Explanation of medical benefits |
| Define clean claim | |
| Define clearinghouse. | |
| Define prior authorization | |
| Define referral | |
| Give a brief explanation of the "birthday rule." | When a husband, wife have a child and then divorce the child is carried on the policy of the parent whose birthday comes first in the calendar year. |
| Give an example of how the "birthday rule" is applied. | Dad's birthday is Jan. 2, 1963, Mom's birthday is May 3, 1962. Mom is older but Dad's birthday (Jan.) comes first in the calendar year. |
Created by:
laholbein
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