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exam review 14 & 15


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