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MB101 Ch 2A
Intro to medical billing
| Question | Answer |
|---|---|
| The identification of disease, and the care and treatment to persons that are sick or injured | medical care |
| medical care plus preventive services | health care |
| a contract between the subscriber and the insurance company to pay for all or part of health care | health insurance |
| Insurance providing income to a policyholder who is temporarily or permanently disabled and cannot work | disability insurance |
| covers losses to a third party caused by the insured or property of the insured; covers medical care, lost wages and pain/suffering | liability insurance |
| Federal legislation that requires employers to cover medical expenses and lost wages for workers injured on the job | Workers compensation |
| Federal legislation that allows employees to continue health care beyond their termination date - must pay premiums | COBRA |
| Provided grants to modernize hospitals; in return, hospitals must provide care to those in need at free or reduced cost | Hill-Burton Act |
| A physician or other health care practitioner | provider |
| A provider who has signed a contract with an insurance company; agrees to accept what insurance pays as payment in full | participating provider |
| A provider who is not under contract with an insurance company; is allowed to charge patient the difference between charge and reimbursement | nonparticipating provider |
| The person who has the insurance policy - in their name | policyholder |
| a person covered under a policyholder's insurance plan | dependent |
| a person responsible for paying the patient's account | guarantor |
| A patient without health insurance that must pay out of pocket for care. | self-pay |
| The insurance plan that is billed first | primary insurance |
| the insurance plan that is billed second | secondary insurance |
| States that the plan of the policyholder whose birth day and month comes first in year is primary | Birthday rule |
| The provider accepts as payment in full what the insurance pays. | Accept assignment |
| The patient gives permission for payment to be sent to the provider. | Assignment of Benefits |
| The amount the patient is responsible for paying before any reimbursement is issued by the insurance policy | deductible |
| A percentage the patient is responsible to pay of the cost of medical services. | coinsurance |
| a flat fee the patient pays each time for medical services | copayment |
| The dollar amount an insurance company deems fair for a specific service or procedure | allowed charge |
| Determines the allowed charge; based on physician work, practice expense, and malpractice insurance costs | RBRVS |
| A list of allowed charges for all services and procedures payable by the insurance company | fee schedule |
| Hospitalization, labs, x-rays, surgical fees, OB care, newborn care, intensive care, chemo | Basic coverage |
| office visits, outpatient, PT and OT, DME, mental health, allergy testing, Rx drugs | Major medical |
| Any condition that was diagnosed and/or treated before a patient's effective date of their insurance policy | preexisting condition |
| Paper form used to file medical claims for physician and outpatient services | CMS 1500 |
Created by:
Kirkster
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