Chapter 7
The greater the medical insurance coverage, the more ________________ the plan.
expensive
________ payment is made by the insurance carrier after the patient has received medical services.
Fee-for-service
Which is one of the largest private-sector payer in the U.S.?
BCBS
Another name for a patient encounter form is
charge slip.
To complete the insurance form, the medical biller/coder needs the dates when James Roberts was unable to work. To find this information, the coder would refer to the
patient's chart.
The Birthday Rule ensures that the maximum benefit will not exceed ______ percent of the charge for covered services.
100
Patient John Parks had a CBC and a PFT performed. Which type of insurance will cover the services?
Basic
A physician who joins an insurance plan is a(n) _____________________.
participating provider
Encounter forms used by the medical practice should be updated __________ and the codes verified with the current year's diagnostic and procedural codes.
annually
Before mailing patient statements, which of the following reports should be reviewed for delinquent accounts?
aging report
According to contract law, when a physician agrees to treat a patient who is seeking medical services, there is a(n) ____________ contract between the two.
unwritten
Which type of payment, by the insurance company to the provider, is made in advance of services rendered?
Capitation
A physician who accepts an assignment of benefits agrees to receive payment directly from the __________.
patient's insurance carrier
An appointment was scheduled for a new patient, who asked how much the fee would be for the visit. What should the administrative medical assistant do?
Provide an estimate of the exam but explain that the estimate is prior to other services, such as blood work.
At the end of her visit, Sarah was asked to pay $15, which is her cost for today's visit through her managed care health plan. The $15 represents Sarah's
copayment.
Double Jeopardy!!!
The rate charged by the insurance policy to the policyholder is the ___________________.
statement
premium
The oldest form of managed care is
HMO
The insurance company is also known as the __________________.
carrier
Double Jeopardy!!!!
Paper insurance claim forms will produce which of the following?
EOB
Listed on an account are the father, the mother, and two minor children. One insurance policy, held by the mother, covers all four family members. Who is the guarantor on the account?
Mother
Which type of insurance plan generally includes coverage of hospitalization, lab tests, surgery, and x-rays?
Basic
PPOs _______ require referrals to specialists.
Do not
Under his insurance plan, Scott is required to have prior approval for his upcoming knee replacement. Before the surgery, the surgeon must have which approval document from the insurance carrier for the surgery?
preauthorization/precertification approval
Which of the following is not necessary information on an insurance claim form?
patient's gender
patient's sexual orientation
insured’s employment data
procedure codes
patient's sexual orientation
Attempted collection of a debt by telephone cannot be made after
9 p.m.