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Office Admin Pt2
| Question | Answer |
|---|---|
| When do you verify patient's insurance plans? | When they schedule their appointments |
| How do you verify a patient's insurance? | 1 of 3 ways: 1) call the insurance, 2) Use an app in the EHR, 3) Use a web-based verification system |
| Policy Holder | Person who buys insurance |
| Premium | How much the insurance costs |
| Benefits | the money the insurance company pays to cover medical bills |
| dependents | spouse or children of the policy holder |
| lifetime maximum benefit | the total amount of money the health plan will pay out over the patient's lifetime |
| Deductible | fixed dollar amount that must be paid by the patient before the insurance company will start to pay any payments |
| Coinsurance | the percentage of charges the patient must pay |
| Copayment | a fixed fee collected at the time of each visit. |
| Exclusions | services that the insurance company will not pay for |
| Preauthorization | providers call the insurance company before procedures or referrals to make sure they will be paid for |
| Precertification | providing MEDICAL NECESSITY to the insurance company before a procedure |
| Medicare | Government healthcare plan for people ages 65 and older |
| Medicaid | Government healthcare plan for people who are low-income, blind, or disabled |
| Advanced Beneficiary Notice (ABN) | document given to medicare beneficiaries indicating the services medicare is unlikely to pay for |
| Tricare and CHAMPVA | military healthcare benefits |
| State Children's Health Insurance Plan (SCHIP) or (CHIP) | provides healthcare to uninsured children |
| Worker's Commpensation | covers employment-related accidents or diseases |
| What is the "birthday rule" when it comes to health insurance? | If a person is covered under 2 difference insurances, the person with the first birthday becomes the primary insurance |
| What form is completed to submit an insurance claim? | CMS-1500 Claim Form |
| What is an encounter form/superbill? | The form the provider gives the patient after their visit. It lists what services were provided that day. They use it to "check out" of their office visit. |
| Full-Block Letter (Block Style) | all lines of the letter are flushed left |
| modified block style | similar to full block but dateline, closing and signature are in the center |
| modified-block style with indented paragraphs | same as modified-block, but the paragraphs are indented |
| simplified style | Excludes complimentary closing, all lines flush with the left margin, subject line in capital letters three lines below the inside address, body of the letter begins three lines below the subject line, signature is in all CAPS four lines below the body |
Created by:
Sxmmerxo