Insurance Terms
Overall, if claims are submitted electronically, the response from the insurance company will be sent
What is electronically
This program is for those over ______ and eligible for social security benefits?
What is 65
Funded by
What is State & Federal
HMO
What is Health Maintenance Organization-must see provider in network
Demographic information needed for a claim is entered at
What is at scheduled appointment or prior on the phone
Improper coding can cause
What is a claim to be denied
Subscriber is also called the
What is policy holder
Federally or state funded?
What is federally
qualification dependent on
What is an individual's monthly income
PPO
What is Preferred Provider Organization-can see provider in or out of network
List of charges for services or procedures
What is a fee schedule
Coding made of up 5 characters
What is CPT
Plan for veterans with permanent service related disabilities and their spouse and children
What is Champva
What is the main type of taxes this is funded by
What is payroll taxes
Signed into law in
What is 1965
Diagnosis codes for claims found here
What is ICD10
Assignment of Benefits allows
What is physicians to receive payment directly from an insurance company for services rendered to a patient.
What are the 2 divisions of a ICD 10 Manual
What is Alphabetic Index and Tabular List
TriCare covers
what is active duty members and their families
Part of Medicare that pays 100% of first 60 days of hospitalization
What is Part A
Dual coverage, both Medicare and Medicaid
What is Medi-Medi
CPT
What is Current Procedural Terminology- codes for medical procedures
Form used for filing paper claims
What is the CMS-1500
The number of categories in a CPT manual
What is 3
When individuals are "dually eligible", Medicare or Medicaid is primary and 1st to cover costs
What is Medicare
Part of Medicare that pays outpatient services
what is Part B
FUN BONUS QUESTION- What are the top 2 states to employ medical assistants
What is California & Texas
Provider who participates in an insurance carrier's plan
What is PAR-participating physician
What is a clearinghouse
What is 3rd party that standardizes claims & checks for errors before submitting for payment
section most frequently used and considered most important in CPT manual
What is E/M-Evaluation & Management
This MCO requires a pre-authorization from PCP or the "gate keeper"
What is HMO
The percent of a medical charge that the patient is responsible for after meeting their deductible
What is coinsurance
CHIP stands for
What is children's health insurance program
EOB/AR
What is Explanation of Benefits- details how much an insurance company will pay for the patient's medical services, which allows the provider to verify the accuracy of the claim/ also for patient to see breakdown between insurance payment and their responsibility
response from insurance company to provider showing payment breakdown
What is Admittance Advice
what designates special circumstances in a procedure
What are modifiers, 2 digit code
MCO & Fee-for-service are the two major types of
what is health plans
Medicare Part B patients pay what percent in coinsurance
What is 20%
Name 4 types of individuals who may qualify for medicaid
What are low income families, children in foster care, blind, medically needy, some over 65yrs
Health care reform with the purpose of providing affordable health care insurance to all
What is ACA-Affordable Care Act
This compares the physicians fee with benefits provided by the patients health plan
What is Review of Allowable Benefits
Name the 6 main CPT sections in Category 1
What are Evaluation & Management, Anethesia, Surgery, Radiology, Pathology & Laboratory, Medicine