A record of medical services provided to a patient and submitted by the provider to the insurance company for payment/request filled by the provider to get payment.
What is a Claim?
100
A type of Managed Care Plan which delivers comprehensive medical care to their members by contracting with different providers to form a network.
What is HMO?
100
Identify the four different programs/plans of Medicare.
1. What is Part A - Hospital Insurance?
2. What is Part B - Medical Insurance?
3. What is Part C - Medicare Advantage HMO, PPO, & FFS?
4. What is Part D - Prescription Drug Plans?
100
Denotes step by step sequence of activities that must be followed to correctly perform the task.
What is Procedure/CPT Codes?
200
CPT stands for
What is Current Procedural Terminology?
200
A percentage cost share for which the member is responsible to pay on a claim
What is a Coinsurance?
200
These plans offer members more freedom in the choice of providers. Patients have direct access to the Specialist.
What is Traditional Indemnity/FFS Plans?
200
A policy sold by private companies which can help pay some of the health care costs that Original Medicare doesn't cover, like copayments, coinsurance, and deductibles.
What is Medigap or Medicare Supplement Insurance?
200
Medical Coding established in 1978 and is intended to be used to identify DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics and Supplies) in a consistent fashion for billing purposes.
What is HCPCS?
300
DEERS stands for
What is Defense Enrollment Eligibility Reporting System?
300
An amount which has to be spent by the insured before the insurer starts covering the medical expenses of the individual is called
What is a Deductible?
300
Requires group health plans to allow employees and dependents to continue their health coverage for a certain amount of time following the loss of eligibility, if that loss is caused by a qualifying event.
What is COBRA?
300
A program financed jointly by federal and state governments, providing medical care and long-term care to many of the nation’s most vulnerable lower-income people.
What is Medicaid?
300
Two-digit codes placed on healthcare professional claims to indicate an Outpatient Service?
What is POS 22?
400
JCAHO stands for
What is Joint Commission on Accreditation of Healthcare Organizations?
400
Process of determining the order of payment between insurances that a member holds
What is Coordination of Benefits?
400
A type of Managed Care Plan which allows members to go outside of the network, as well as schedule appointments and receive treatment from specialists without first obtaining a referral from a PCP.
What is Preferred Provider Organization (PPO)?
400
A tax-advantaged medical savings account available to taxpayers in the United States who are enrolled in a high-deductible health plan (HDHP).
What is Health Savings Account (HSA)?
400
A modifier used to report diagnostic, radiology and surgical procedures. It applies to any bilateral procedure performed on both sides at the same session.
What is Modifier 50?
500
HIPAA stands for
What is Health Insurance Portability and Accountability Act of 1996?
500
A process of making decision on a claim sent by the provider.
What is Claims Adjudication?
500
A type of Managed Care Plan which offers members maximum freedom to decide wether to go to a PCP and then to Specialist or directly choose to go to a ONN specialist skipping the PCP.
What is Point-of-Service (POS)?
500
Identify the three categories for an individual to qualify for Medicare.
1. What is 65yrs or above?
2. What is permanently or temporarily disabled and has received Social Security
Disability benefits for a period of minimum 24 months?
3. What is ESRD- End Stage Renal Disease-Any individual who had a kidney failure?