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CMA NHA
Practice test
| Term | Definition |
|---|---|
| Private Insurance | Provided by a person's employer |
| Primary Insurance | Insurance that is filed first and is the main insurance for a person |
| Premium | The amount of money that a person pays for their insurance |
| Secondary Insurance | Double coverage, for example, your work and your parent's insurance. |
| Self Insured | A person pays for their insurance, usually for people who are self employed. |
| Self pay | People who have no coverage and would be expected to pay at the time of serivce. Some placess will offer special pricing for self paying individual |
| Government Plans | Special programs by state and federal government that provides insurance for elderly, indignet, and for children |
| Co-pay | A specified sum of money based on the patient's insurance policy benefits due at the time of service |
| Deductibles | A specific amount of money a patient must pay out of pocket before the insurance carrier begins paying for serices. It usually on calendar year accurual basis. |
| Explanation of Benefits (EOB) | Provided to the patient by the insurance company as a statement that details what services were paid, denied, or reduced in payment. It also includes info that pertains to the amount applied to the deductible, coinsurnace or other allowed amounts. |
| Co-insurance | A percentage of the total cost that an individual must contribute toward each serice. For example, 90%/10% or 80%/20%, the insurance pay 90% while you pay 10% |
| Remittance advice (RA) | AN EOB sent to the provider from the insurance carrier. It's similar to the EOB, the Ra contains multiple patients and providers. It also includes the electronic funds transfer info or check for payment. |
| Advance beneficiary notice (ABN) | A form that a medicare patient will sign when the provider thinks medicare won't pay for a specific service or item. |
| Medicare | Patients 65 years or older for Part A(hospitalization) Part B(routine office visits) Part D(prescription coverage) |
| Tricare | Authorizes dependents of miltary personnel to see civilian practitioners. |
| CHAMPVA | Covers surviving spouses and dependent children of veterans who died in service-related disabilities |
| Medicaid | Health insurace to the medically indigent population through a cost sharing program between federal gov and states. Covers women of child bearing age and children until when the child turn 18 year old. |
| Worker's Compensation | A state legislative law that protects emplotees against the cost of medical care resulting form a work-related inury |
| CHIP | It stand for children's health insurance program-offers low cost health coverage for children from birth through age 18. Designed for families who earn too much to qualify for medicaid, but cannot afford to buy private health coverage. $35-$50/year |
| Group Policies | Offered via person's employer who will usually pay a portion of the premium and then deduct the remainder of the premium from the employee's pay |
| Individual Policies | Insurnace plans that an individual funds themselves. Patients might pay the entire premium themselves if they are self-employed |
| HMO (Health Maintenance Organization | A type of health insurance paln that usually limits coverage of care from doctors who work for or contract with the HMO. It generally won't cover out of network care except in an emergency. |
| PPO (Preferred Provider Organization) | A medical care arrangment in which medical professionals and facilities provide service to subscribe clinets at reduced rate. |
| Health Savings Account (HAS) | A savings account that can be used to apy for medical expenses. These funds are not taxed until the time of withdrawal. |
| Flexible Spending Account (FSA) | The account is funded with pretax dollars by an employee. Do not roll over to the next year. You may lost the funds if you are not used it. |
| ICD-10-CM | It stand for internationl Classification of Diseases, a system used by physicians to classify and code all diagnoses, symptoms and procedures for cliams processing. For exam R42 means dizzines |
| Upcoding | When a healthcare provider has submitted codes for more severe conditions than diagnosed for the patient to receive higher reimbursement. |
| CMS-1500 form | standardized medical claim form used by individual healthcare providers, such as physicians, therapists, and midwives, to submit billing information for services provided to patients. |
| Referrals | A document or form required by insurance companies that is used when a provider wants to send a patient to a specialist. |
| Participating Provider | The provider and the insurance company have agreed between the amounts charged and approved and what will and will not be reimbursed |
| Account balance | The total amount owed on an account |
| Debit | An amount owed |
| Accounts receivable | Money owed to the provider |
| Accounts payable | Debts incurred and not yet paid |
| Credit | A monetary balance in an individual's favor |
| Assets | THe entire saleable property of a person, association, corporation or estate applicable or subject to the payment of debts |
| Liabilities | Amounts owed;debt |
| Electronic Medical Record (EMR)/Electronic Health Record (HER) | A digital chart that is used in the facility |
| Electronic Health Record (HER) | Includes the EMR and other info to be used between more than one facility |
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