Medical Insurance: An Integrated Claims Approach Process Chapter 1
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
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| What Are third Party Payers? | show 🗑
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| Who generally files claims for Patients? | show 🗑
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| What does participation mean? | show 🗑
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| What Benefits does participation bring? | show 🗑
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| show | A 100% Federally funded health plan that covers people 65 y/o and over, are disabled, or have permanent kidney failure (ESRD)
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| show | A jointly funded State and federal health plan for low-income people?
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| show | Medical expenses are covered by The Department of Defense for active duty members, and their spouses, children and other dependents. Also covered are retired military personal and their dependents.
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| show | The Civilian Health and Medical Program of the Department of Veteran Affairs. It covers veterans with permanent service-related disablities and their dependent. Also covers dependents and spouses.
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| What is a Practice Management system? | show 🗑
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| What is a Typical Practice Size? | show 🗑
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| show | The internet offers many official websites that help keep Medical Billers and Coders up-to-date with the latest updates, instructions, and rules for their specialty. Ignorance on these items is not an excuse for incorrect billing.
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| show | 1. Knowledge of medical terminology, anatomy, physiology and medical coding
2. Communication Skills
3. Attention to detail
4. Flexibility
5. Information technology (IT) skills
6. Honesty and Integrity
7. Ability to work as a ream member.
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| show | An organization that contracts with a network of providers for the delivery of health care for a prepaid premium
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| Capitation | show 🗑
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| Schedule of benefits | show 🗑
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| show | A retroactive reimbursement method based on providers' charges.
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| show | The percentage of each claim that an insured person must pay
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| show | The amount of money that an insured person must pay before reimbursement for medical expenses begins
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| show | An amount that an insured person pays at the time of a visit to a provider
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| Premium | show 🗑
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| Preferred Provider Organization | show 🗑
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| show | A health plan that that reimburses policyholders based on the fees charged.
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| In an HMO with a gatekeeper system,a ___________ coordinates that patient's care and provides referrals. | show 🗑
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| show | POS (Point-of-service)
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| Health plans pay for __________ services. | show 🗑
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| In an HMO, securing _________ may be required before services are provided. | show 🗑
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| A self-insured health plan may use its own.... | show 🗑
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| Unlike an HMO, a PPO permits its member to use ___________, but at a high cost. | show 🗑
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| The major government-sponsored health programs are.... | show 🗑
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| Coinsurance is calculated based on.... | show 🗑
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| When a patient has insurance coverage for which the practice will create a claim, the patient bill is usually done... | show 🗑
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| show | collection process
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| List at least four important skill of medical insurance specialists. | show 🗑
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| List the ten steps in the medical billing process... | show 🗑
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| show | True
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| show | False
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| show | True
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