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Insurance 3

Insurance chapter 3

Question	Answer
An ___________ is a legally enforceable agreement or contract	insurance contract
an individual promising to pay for medical services rendered is known as a ___________	guarantor
5 Health insurance policy renewal provisions	cancelable, optionally renewable, conditionally renewable, guaranteed renewable, noncancelable
insurance reimbursement or payment is also called ___________	indemnity
Name 2 general health insurance policy limitations	exclusions, wavier or rider
the act of determining whether treatment is covered under an individual's health insurance policy is called _________________	percertification
The procedure to obtain permission for a procedure before it is done, to determine whether the insurance program agrees it is medically necessary, is termed _____________	preauthorization
Determining the maximum dollar amount the insurance company will pay for a procedure before it is done is known as	predetermination
name 3 ways an individual may obtain health insurance	take out insurance through a group plan, pay the premium on an individual basis, enroll in a prepaid health plan
list 4 methods of a physician's practice may use to submit insurance claims to insurance companies	manual claims submission on revised CMS-1500 claim form, electronic claims transmitted from in office computers, contracting with an outside service bureau to prepare and transmit, direct data entry into payers system
a document signed by the directing the insurance company to pay benifits directly to the physician is known as a _____	assignment of benifits
a patient service slip personalized to the practice of the physician and used as a communication/ billing tool during routing of the patient is also known as a _______	encounter form, tranaction slip, charge slip, fee ticket, routing form, multipurpose billing form, patient service slip, superbill
For electronic access to computer data, computerized signatures may consist of the following verification or access methods	series of numbers, series of letters, electronic writting, voice, fingerprint transmission, computer key
Guidelines for avoiding unauthorized use and preventing problems when a medical practice uses a facsimile signature stamp are	make one stamp, allow only long-term, trusted, bonded staff members to have access to the stamp, keep the stamp in a location with a secure lock, limit access to the stamp
an insurance company takes into account benifits payable by another carrier in determining its own liability	Coordination of benifits (COB)
benifits paid by an insurance company to an insured person	Indemnity
Transfer of ones right to collect an amount payable under an insurance contract	assignment
time that must elapse before an indemnity is paid	waiting period
acts for insurance company or insured in settlement of claims	adjuster
periodic payment to keep insurance policy in force	premium
amount insured person must pay before policy will pay	deductible
time period in which a claim must be filed	time limit
certain illness or injuries listed in a policy that the insurance company will not cover	exclusions
insurance company that carries the insurance	carrier
one who belongs to an insurance plan	subscriber
when a patient goes to a physicians office to seek medical services, the physician accepts the patient and agrees to render treatment,and both parties agree, this contract is known as a	implied contract
the process of checking and confirming that a patient is covered under an insurance plan is known as	eligibility verification
a provision that allows the policyholder the right to refuse to renew the insurance policy on a premium due date is called	optionally renewable
a provision in a health insurance policy in which two insurance carriers work together for payment so that there is no duplication of benifits paid between the primary insurance carrier and the secondary insurance carrier is called	coordination of benifits (COB)
a type of tax free savings account that allows individuals and their employers to set aside money to pay for health care expenses is known as	health savings accounts, medical savings accounts, flexible spending accounts
time limits for filing insurance claims to a comercial carrier may have a range of	30 days from the date of service to 1 1/2 years
if a physician belongs to a preferred provider organization (PPO) and does not foloow his or her contract with the PPO, the patient is liable for the bill	False
the birthday law is a change in the order of determination of coordination of benifits (COB) regarding primary and secondary insurance carriers for dependent children	True
the consolidated omnibus budget reconciliation act of 1985 (COBRA) mandates that when an employee is laid off from a company, the group health insurance coverage must continue at group rates for up to 18 months	True
capitation is a system of payment used by managed care plans in which a member physician is paid different amounts monthly for each patient enrolled	False
a providers signiture on a CMS-1500 claim form is acceptable as a handwritten, a facsimile stamp, or an electronic signature	True

Created by: Lea99

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