Health Insurance Basics
What is an insurance policy?
Product offered by the insurance company and defines how much the insurer will may in BENEFITS.
True or False: Insurance companies offer many different policies and costs vary widely
TRUE
Define Medicare
A government funded health insurance program for people 65 and older, who have end-stage kidney disease and other disabilities
What is the ICD (define I, C and D)
International Classification of Disease
Is credit money coming in or out
Money coming IN
Define insurance claim
After care is provided, this is the request for payment from the insurance company typically paying the provider/doctor directly
What is the term of the money needed to pay at each doctors visit. Ex: Every time you visit the primary care doctor you pay a $20 __________
Copayment or copay
Define Medicaid
government program to given health insurance to adults/children with a very low income
What is the purpose of the International Classification of Disease (ICD)
Medical coding system used to track disease and death information around the world. It provides guidance on what services are needed and used for coding most in hospital procedures.
IS debit money coming in or out
Money going OUT
family members who receive insurance through their parent or spouse
Coinsurance
What is the Children's Health Insurance Program (CHIP)
A government plan for families/pregnant women with lower incomes but not low enough for medicaid
Current Procedural Terminology
What should the MA do if a patient pays in cash
Count the money in front of the patient and provide a receipt
What are the monthly payments called to purchase insurance
Premiums
What was the law enacted in 2010 that lists certain preventative services to be covered at no cost and allowed kids to stay on their parents health insurance until 26
Patient Protection and Affordable Care Act (ACA)
Obamacare
What is TRICARE
health insurance of the US military for current and former members
What is CPT codes used for
Codes used to bill insurance companies for procedures in offices
When is a payment known as delinquent
if it is overdue
What is the term for the amount of money the insured person must pay before the insurance company pays any money
Deductible
What is an out-of-pocket maximum
True or False: all doctors offices are required to accept Medicare, Medicaid, TRICARE and CHIP
False
So billing can be accurate and doctors can be reimbursed appropriately
Define Accounts Payable (AP) and Accounts Receivable (AR)
Planned expenses (what they will be spending money on)
Expected income, money coming in from patients/insurance companies