Insurance/Billing
A common reason why insurance claims are rejected
What is
Claim sent to wrong insurance plan
NPI
What is
National Provider Identification
A federal and state funded insurance program for the medically indigent
Medcaid
Explanation of benefits (EOB)
What is
A document sent by the insurance company to the provider and the patient explaining all charges and payments
What kind of policy cover multiple people under a single contract issued by an employer
What is
Group policy
T/F
A provider can choose whether they want to accept Medicaid patients
What is
TRUE
CMS
What is
Centers for Medicare and Medicaid Services
What services are covered by Medicaid
What is
Inpatient hospital services, family planning, midwifery services
Fee Schedule
What is
A list of fixed fees for services
When the diagnosis code and procedure code do not match, they claim will not show what
What is
Medical necessity
When should insurance information be collected
What is
On the patients first visit
HMO
What is
Health Maintenance Organization
What is an example of an Medicaid HMO policy
What is
Caresource
Claim
What is
A formal request for payment from an insurance company for services provided
How do we determine the patient's insurance eligibility
What is
Provider web portal
Health insurance designated for military dependents and retired military personnel
What is
Tricare
ACA
What is
Affordable Care Act
What services are included in the Affordable Care Act
What is
Emergency services, laboratory services, prescription drug coverages
What is
A written agreement between two parties in which one party agrees to pay another party if certain specified circumstances occur
An online marketplace where you can compare and buy individual health insurance plans
What is
Health insurance exchange
When considering the birthday rule, which insurance is considered primary
The person's birthday who comes first in the year
RBRVS
What is
Resource-based relative value scale
What is
A. Inpatient hospital
B. Ambulatory Care (physician office visits)
C. Turns part A and C into a private plan
D. Prescription drug coverage
Beneficiary
What is
A designated person who receives funds from an insurance policy
A payment arrangement for healthcare providers in which the provider is paid a set amount whether the patient received services or not
What is
Capitation