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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| authorization | show 🗑
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| beneficiary | show 🗑
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| birthday rule | show 🗑
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| capitation | show 🗑
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| show | With regard to insurance, a company that assumes the risk of an insurance policy.
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| Civilian Health and Medical Program of the Veterans Administration (CHAMPVA) | show 🗑
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| show | A policy provision frequently found in medical insurance whereby the policyholder and the insurance company share the cost of covered losses in a specified ratio. For example, 80/20 means 80% is covered by the insurer and 20% by the insured.
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| show | Plans that reimburse the insured for expenses resulting from illness or injury according to a specific fee schedule as outlined in the insurance policy and on a fee-for-service basis; sometimes called private insurance.
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| co-payment | show 🗑
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| deductible | show 🗑
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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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| effective date | show 🗑
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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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| explanation of benefits (EOB) | show 🗑
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| show | An explanation of benefits from Medicare.
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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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| group policy | show 🗑
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| guarantor | show 🗑
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| show | Protection in return for periodic premium payments that provides reimbursement of expenses resulting from illness or injury.
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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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| show | A federal- and state-sponsored health insurance program for the medically indigent.
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| show | Tax-deferred bank or savings accounts that are combined with a low-premium, high-deductible insurance policy; they are designed for individuals or families who choose to fund their own healthcare expenses and medical insurance.
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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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| show | A physician or other healthcare provider who enters into a contract with a specific insurance company or program and by doing so agrees to abide by certain rules and regulations set forth by that particular third-party payer.
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| policyholder | show 🗑
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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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| referral | show 🗑
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| remittance advice (RA) | show 🗑
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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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| rider | show 🗑
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| show | An insurance plan funded by an organization having a large enough employee base that it can afford to fund its own insurance program.
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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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| third-party administrator (TPA) | show 🗑
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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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| show | Insurance against liability imposed on certain employers to pay benefits and furnish care to injured employees and to pay benefits to dependents of employees killed in the course of or because of circumstances arising from their employment.
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Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
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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.
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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