Question 1

Identify 3 ways that medical insurance specialists help ensure the financial success of physician practices

Accepted Answer

* following all procedures carefully
* Communicating effectively with patient  and with those who work in the practice.
*Using health information technology skills to work with practice management programs and electric health records

Question 2

Differentiate between covered and noncovered services under medical insurance policies

Accepted Answer

COVERED SERVICISES:
1. May include primary care, emergency care, medical specialists services and surgery
2. Are eligible for members
3. Are listed under the schedule of benefits of an insurance policy

Question 3

Differentiate between covered and noncovered services under medical insurance policies

Accepted Answer

NONCOVERED SERVICES:
1. Are identified by the insurance policy as services for which it will not pay

Question 4

Compare indemnity and manage care approaches to health plan organization

Accepted Answer

* All insurance plans are based on 1of the 2 essential types of plans, indemnity, and managed care
* Under an indemnity  plan, the payer protects the member against loss from the cost of medical services, & procedures.

Question 5

Compare indemnity and manage care approaches to health plan organization

Accepted Answer

Manage car offers a more restricted  choice of providers and treatments in exchange for lower premiums, deductibles, and other charges.

Question 6

Discuss 3 examples of cost containment  employed by health maintenance organization

Accepted Answer

Health maintenance organization(HMO) control healthcare costs by:
 Creating a restricted number of physicians for members
 Requiring preauthorization of services
 Controlling the use of services
 Controlling drug costs
 Using cost-sharing methods

Question 7

Explain how a preferred provider organization work

Accepted Answer

Create a network of hospital and other providers for members to use at negotiated, reduced fees

Are the most popular type of health care.

Generally require the payment of premiums  and copayment  from patients.

Question 8

Describe 2 elements that are combined in a consumer driven health plan

Accepted Answer

Consumer driven health plans (CDHP's) combine a high-deductible, low premium PPO with a pretax savings a account to cover out- of-pocket medical expenses up to the amount of the deductible

Question 9

three major types of medical insurance payers

Accepted Answer

Private payers of health benefits are either insurance companies or self-insured employers.
Most private health insurance is employer sponsored
Government-sponsored healthcare programs include Medicare, Medicaid, Tricare, and CHAMPVA

Question 10

Analyze how professionalism, ethics, and etiquette contributes to career success.

Accepted Answer

It is vitally important for all members of the medical office to posses these traits 
Office members acquire the proper skill & develop the necessary attributes in order to perform their work successfully
Pair character. w/ a strong code of ethics/etiqu

Question 11

Evaluate the importance of professional certification of career advancement

Accepted Answer

Medical staff personnel advance their careers through membership in a professional organization and by receiving cerif. by that organization.
Certification are earned through a combination of education, experience, and an exam

Question 12

Revenue Cycle Steps  
Step 1

Accepted Answer

Step 1
 Pre register the patient

Question 13

Revenue Cycle Steps 
Step 2

Accepted Answer

Step 2 
Establish financial responsibility

Question 14

Revenue Cycle Steps
Step 3

Accepted Answer

Step3
Check in patient

Question 15

Revenue Cycle Steps 
Step 4

Accepted Answer

Step 4
Review coding compliance

Question 16

Revenue Cycle Steps
Steps 5

Accepted Answer

Step 5
Review billing compliance

Question 17

Revenue Cycle Steps 
Step 6

Accepted Answer

Step 6
Check out patient

Question 18

Revenue Cycle Steps
Step 7

Accepted Answer

Step 7
Prepare and transmit claims

Question 19

Revenue Cycle Steps
Step 8

Accepted Answer

Step 8
Monitor payer adjudication

Question 20

Revenue Cycle Steps 
Step 9

Accepted Answer

Step 9
Generate patient statements

Question 21

Revenue Cycle steps
Steps 10

Accepted Answer

Step 10 
Follow up payments and collections

chp1 summary revenue

summary for chp 1 revenue cycle mbc insuranc

Question	Answer
Identify 3 ways that medical insurance specialists help ensure the financial success of physician practices	* following all procedures carefully * Communicating effectively with patient and with those who work in the practice. *Using health information technology skills to work with practice management programs and electric health records
Differentiate between covered and noncovered services under medical insurance policies	COVERED SERVICISES: 1. May include primary care, emergency care, medical specialists services and surgery 2. Are eligible for members 3. Are listed under the schedule of benefits of an insurance policy
Differentiate between covered and noncovered services under medical insurance policies	NONCOVERED SERVICES: 1. Are identified by the insurance policy as services for which it will not pay
Compare indemnity and manage care approaches to health plan organization	* All insurance plans are based on 1of the 2 essential types of plans, indemnity, and managed care * Under an indemnity plan, the payer protects the member against loss from the cost of medical services, & procedures.
Compare indemnity and manage care approaches to health plan organization	Manage car offers a more restricted choice of providers and treatments in exchange for lower premiums, deductibles, and other charges.
Discuss 3 examples of cost containment employed by health maintenance organization	Health maintenance organization(HMO) control healthcare costs by: Creating a restricted number of physicians for members Requiring preauthorization of services Controlling the use of services Controlling drug costs Using cost-sharing methods
Explain how a preferred provider organization work	Create a network of hospital and other providers for members to use at negotiated, reduced fees Are the most popular type of health care. Generally require the payment of premiums and copayment from patients.
Describe 2 elements that are combined in a consumer driven health plan	Consumer driven health plans (CDHP's) combine a high-deductible, low premium PPO with a pretax savings a account to cover out- of-pocket medical expenses up to the amount of the deductible
three major types of medical insurance payers	Private payers of health benefits are either insurance companies or self-insured employers. Most private health insurance is employer sponsored Government-sponsored healthcare programs include Medicare, Medicaid, Tricare, and CHAMPVA
Analyze how professionalism, ethics, and etiquette contributes to career success.	It is vitally important for all members of the medical office to posses these traits Office members acquire the proper skill & develop the necessary attributes in order to perform their work successfully Pair character. w/ a strong code of ethics/etiqu
Evaluate the importance of professional certification of career advancement	Medical staff personnel advance their careers through membership in a professional organization and by receiving cerif. by that organization. Certification are earned through a combination of education, experience, and an exam
Revenue Cycle Steps Step 1	Step 1 Pre register the patient
Revenue Cycle Steps Step 2	Step 2 Establish financial responsibility
Revenue Cycle Steps Step 3	Step3 Check in patient
Revenue Cycle Steps Step 4	Step 4 Review coding compliance
Revenue Cycle Steps Steps 5	Step 5 Review billing compliance
Revenue Cycle Steps Step 6	Step 6 Check out patient
Revenue Cycle Steps Step 7	Step 7 Prepare and transmit claims
Revenue Cycle Steps Step 8	Step 8 Monitor payer adjudication
Revenue Cycle Steps Step 9	Step 9 Generate patient statements
Revenue Cycle steps Steps 10	Step 10 Follow up payments and collections

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