Insurance
Medical insurance for dependents of active duty or retired military personnel and their dependents:
What is:
Tricare
Term for the amount of money that the insured must pay for medical services before the policy begins to pay:
What is:
Deductable
The ICD-9-CM volume that is recommended as a first reference for coding diagnoses, is volume ____:
What is:
Volume II
Type of insurance policy that provide coverage on a fee-for-service basis:
What is:
Traditional insurance
The term for the name of the person covered under the policy.
What is:
Beneficiary
Medicare coverage that pays for prescription drugs:
What is:
Medicare Part D
When the insurance pays a percentage of the balance after the deductible is paid.
What is:
Co-insurance
An alphabetic index of ICD-10-CM is Volume ____:
What is:
Volume II
In the office, this item should be used to check for patient eligibility:
What is:
Point-of-service device
The term for obtaining a consent from the insurance for care and treatment.
What is:
Preauthorization
Insurance coverage for persons injured on the job:
What is:
Workers' Compensation
A rule for a dependent child when both parents are covered by health insurance:
What is the:
Birthday rule
The coding book used for services and procedures performed in the medical office:
What is the:
CPT
Before certain procedures or visits can be made, some insurance policies require:
What is:
Preauthorization
(Categories: Regular, Urgent, STAT)
What is the most current manual for coding of medical diagnoses called?
What is:
ICD-10-CM
Fee system for allowable charges that will be accepted by insurance carriers:
What is:
UCR (Usual, customary, reasonable)
A term for when more than one policy covers the individual, and a decision is made for which one is billed first:
What is:
Coordination of benefits
ICD codes used for health factors or history:
What is:
V-Codes
When the insurance is billed at a higher rate for what was performed, in order for the provider to obtain a greater reimbursement.
What is:
Up-coding
Up-coding is illegal
True or False
Medicaid eligibility is for individuals that are 65 and older or have disabilities.
What is:
False
The correct answer is Medicare
Medicaid is for qualifying low-income individuals
Term for the amount of charges the provider would have to write off if the insurance did not cover it:
What is:
Adjustment
True or False
Health insurance was designed to help individuals and families compensate for high medical costs.
What is:
True
Codes used for injury or poisoning:
What is:
E-Codes
Diagnosis codes used primarily with cancer registries:
What is:
M codes
True or False:
"First party" is known as the person who is receiving the contracted service. Ex: Patient
What is:
True
2. Second party is the organization providing the service. Ex: Dr. Office
3. Third party is involved with reimbursement procedures. Ex: Insurance Company