KINNS Ch 20
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| allowed charge (allowable amount) | show 🗑
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| show | A term used in managed care for an approved referral.
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| show | An individual entitled to receive benefits from an insurance policy or program or a government entitlement progra m offering healthcare benefits. Also called a participant, subscriber, dependent, enrollee, or member.
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| show | When an individual is covered by two insurance policies, the insurance plan of the policyholder whose birthday comes first in the calendar year (month and day, not year) becomes the primary insurance.
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| show | A payment method used by many managed care organizations in which a fixed amount of money is reimbursed to the provider for patients enrolled during a specific period of time, no matter what services are received or how many visits are made.
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| show | With regard to insurance, a company that assumes the risk of an insurance policy.
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| show | A health benefits program run by the Department of Veterans Affairs (VA) that helps eligible beneficiaries pay the cost of specific healthcare services and supplies.
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| co-insurance | show 🗑
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| commercial insurance | show 🗑
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| co-payment | show 🗑
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| show | A specific amount of money a patient must pay out of pocket before the insurance carrier begins paying, usually $100 to $500. The deductible amount is met on a yearly or per-incident basis.
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| show | The spouse, child, and sometimes domestic partner or others designated by the insured who are covered under a healthcare plan.
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| show | Insurance that provides periodic payments to replace income when an insured person is unable to work as a result of illness, injury, or disease.
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| show | The date on which an insurance policy or plan takes effect so that benefits are payable.
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| eligibility | show 🗑
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| show | Limitations on an insurance contract for which benefits are not payable.
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| show | A letter or statement from the insurance carrier describing what was paid, denied, or reduced in payment. It also contains information about amounts applied to the deductible, the patient's co-insurance, and the allowed amounts.
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| explanation of Medicare benefits (EOMB) | show 🗑
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| show | Plans in which an established schedule of fees, which are paid by the patient, is set for services performed by providers.
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| show | An organization that contracts with the government to handle and mediate insurance claims from medical facilities, home health agencies, or providers of medical services or supplies.
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| government plans | show 🗑
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| show | Insurance written under a policy that covers a number of people under a single master contract issued to their employer or to an association with which they are affiliated.
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| guarantor | show 🗑
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| health insurance | show 🗑
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| show | It was designed to improve the portability and continuity of health insurance coverage
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| show | An organization that provides a wide range of comprehensive healthcare services for a specified group for a fixed, periodic payment.
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| indemnity plans | show 🗑
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| show | An insurance policy designed specifically for the use of one person (and his or her dependents); it does not offer the benefit of the lower premiums available through a group policy. Often called personal insurance.
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| show | An individual or organization covered by an insurance policy according to the policy terms, usually the individual or group that pays the premiums. Blue Cross/Blue Shield refers to this person or group as the subscriber.
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| managed care plans | show 🗑
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| Medicaid | show 🗑
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| medical savings accounts (MSAs) | show 🗑
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| show | A federally sponsored health insurance program for those over age 65 or individuals under age 65 who are disabled.
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| show | A term sometimes applied to private insurance products that supplement Medicare insurance benefits.
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| participating provider (PAR) | show 🗑
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| show | A person who pays a premium to an insurance company and in whose name the policy is written in exchange for the insurance protection provided by a policy of insurance.
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| preauthorization | show 🗑
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| premium | show 🗑
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| show | A general practice or nonspecialist provider or physician responsible for the care of a patient for some health maintenance organizations. Also called a gatekeeper.
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| show | An insurance term used when a primary care provider wants to send a patient to a specialist. Typically, the provider must obtain authorization from the insurance carrier in advance to refer a patient.
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| show | An explanation of benefits that comes from Medicaid; see explanation of benefits.
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| show | A fee schedule designed to provide national uniform payment of Medicare benefits after being adjusted to reflect the differences in practice costs across geographic areas.
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| show | A special provision or group of provisions that may be added to a policy to expand or limit the benefits otherwise payable. It may increase or decrease benefits, waive a condition or coverage, or in any other way amend the original contract.
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| self-insured plan | show 🗑
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| self-referral | show 🗑
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| show | Plans that provide benefits in the form of certain surgical and medical services rendered rather than cash. A service benefit plan is not restricted to a fee schedule.
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| show | An organization that processes claims and performs other business-related functions for a health plan.
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| show | A person other than the patient, spouse, or parent who is responsible for paying all or part of the patient's medical costs.
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| show | A government-sponsored program wherein authorized dependents of military personnel receive medical care. Formerly called the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS).
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| show | A review of individual cases by a committee to make sure services are medically necessary and to study how providers use medical care resources.
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| workers’ compensation | show 🗑
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To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
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