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Insurance Billing
Insurance Billing YCST Chap 3 Terms
| Question | Answer |
|---|---|
| What is a transfer or an individual's legal right to collect an amount payable under an insurance carrier? | assignment |
| What is a renewal provision in an insurance agreement that grants the insurer the right to cancel the policy at any time and for any reason? | cancelable |
| What is a bill sent to an insurance carrier requesting payment for services rendered? | claim |
| What is a cost-sharing requirement under a health insurance policy providing that the insured will assume a percentage of the costs for covered services? | coinsurance |
| What is an insurance policy renewal provision that grants the insurer a limited right to refuse to renew a health insurance policy at the end of a premium payment period? | conditionally renewable |
| What is a legally enforceable agreement when relating to an insurance policy? | contract |
| What are two insurance carriers working together and coordinating the payment of their benefits so that there is no duplication of benefits paid between the insurance carriers? | COB |
| What is a specific dollar amount that must be paid by the insured before a medical insurance plan or government program begins covering health care costs? | deductible |
| What are qualifying factors that must be met before a patient receives benefits under a specified insurance program or government program? | eligibility |
| Who is a person younger than 18 years of age who lives independently, is totally self supporting, and possesses decision-making rights? | emancipated minor |
| What is an all-encompassing billing form personalized to the practice of the physician? | encounter form |
| This is a type of managed health care plan that combines features of HMOs and PPOs. It is referred to as "exclusive" because it is offered to large employers who agree not to contract with any other plan. | EPO |
| What is a clause in an insurance policy that means the insurance company must renew the policy as long as premium payments are made? | guaranteed renewable |
| Who is an individual who promises to pay the medical bill by signing a form agreeing to pay or who accepts treatment, which constitutes an expressed promise? | guarantor |
| What is a contract between the policy holder or member and the insurance company and/or government program to reimburse the policyholder or member for all or a portion of the cost of medical care rendered? | health insurance |
| What is the oldest of all repaid health plans? It is a comprehensive health care financing and delivery organization that provides a wide range of health care services. The PCP is the "gatekeeper". | HMO |
| Who is an individual or organization protected in case of loss under the terms of an insurance policy? | insured |
| What is a health insurance policy designed to offset heavy medical expenses resulting from catastrophic or prolonged illneses or injury? | major medical |
| What is a federally aided, state-operated, and state-administered program that provides medical benefits for certain low-income persons in need of health and medical care? | Medicaid |
| What is a nationwide health insurance program for persons age 65 years of age and older and certain disabled or blind persons regardless of income, administered by the CMS? | Medicare |
| Who is a person who is covered under an insurance program's contract? | member |
| What is an insurance policy clause that means the insurance company cannot increase premium reates and must renew the policy until the insured reaches the age stated in the contract? | noncancelable policy |
| Who is a provider who decides not to accept the determined allowable charge from an insurance plan as the full fee for care? | nonpar - nonparticipating provider |
| What is an insurance policy renewal provision in which the insurer has the right to refuse to renew the policy on a date and may add coverage limitations or increase premium rates? | optionally renewable |
| Who is a person who accepts the determined allowable charge from an insurance plan as the full fee for care? | par - participating provider |
| What is a questionarre designed to collect demographic data and essential facts about medical insurance coverage for each patient seen for professional services? | patient registration form |
| What is an insurance plan issued to an individual? | personal insurance |
| What is a managed care plan in which members are given a choice as to how to receive services? | POS |
| What is a requirement of some health insurance plans to obtain permission for a service or procedure before it is done and to see whether the insurance program agrees it is medically necessary? | preauthorization |
| What is a procedure that is done to determine whether treatment is covered under a patient's health insurance policy? | precertification |
| What is illnesses or injuries acquired by the patient before enrollment in an insurance plan? | pre-existing conditions |
| What is a type of health benefit program in which enrollees receive the highest level of benefits when they obtain services from a physician, hospital, or other health care provider? | PPO |
| What is the cost of insurance coverage paid annually, semiannually, or monthly to keep the policy in force? | premium |
| What is a managed health care program offered to spouses and dependents of service personnel? | TRICARE |
| What is a contract that insures a person against on-the-job injury or illness? | WC |
Created by:
dsljulian
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