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Coverage
Insurance
Medicare
One Word Questions
Blue Cross - Blue Shield
100
Physician who is trained in a certain area of medicine
What is Specialist
100
Limit to the amount of money a policyholder has to pay out of pocket for any one incident or in any one year.
What is Insurance Cap
100
Hospital insurance
What is Medicare part A
100
Insurance policies sold by private insurance companies to fill "gaps" in the original Medicare plan coverage
What is Medigap
100
POS
What is Point of Service
200
Document prepared by the carrier that gives details of how the claim was adjudicated. It typically includes a comprehensive listing of patient information, dates of service, payments, or reasons for nonpayment.
What is Explanation of benefits (EOB)
200
Contract between an insurance company and an employer.
What is Group Insurance
200
Pays a portion of prescription drug expenses and cost sharing for qualifying individuals
What is Medicare part D
200
Improper or harmful procedures or methods of doing business that are contradictory to accepted business practices.
What is Abuse
200
PPO
What is Preferred provider Organization
300
The patient in the implied contract between the physician and patient.
What is party of the first part (1st Insurance)
300
Traditional healthcare insurance where patients can choose any provider or hospital they want (including specialist) and change physicians at any time.
What is indemnity (fee-for-service)
300
Medical (physician's care) insurance (this is the original medicare)
What is Medicare part B
300
Certain amount of money that the patient must pay each yr. toward his or her medical expenses
What is Deductible
300
In 1929 this person introduced a plan to guarantee schoolteachers 21 days of hospital care for $6.00 a year.
Who is Justin Ford Kimball
400
Together with the Health Care and Education Reconciliation Act, it represents the most significant regulatory overhaul of the country's healthcare system since the page of Medicare and Medicaid in 1965.
What is the Affordable Care Act
400
Individuals who are covered under a managed care plan
What is Enrollees
400
Prescription drugs program established on Jan 1, 2006
What is Medicare part C
400
Intentional deception or misrepresentation that the individual or entity makes, knowing that the misrepresentation could result in some authorized benefits to the individual or the entity or to another party
What is Fraud
400
Have not signed contracts Expect to be paid full fee Patient pays provider in full. Reimbursed by BCBS for allowed fee Payment is sent directly to patient
What is a Nonparticipating Provider
500
Aged or disabled individuals who are very poor are covered under the Medicaid & Medicare programs.
What is Dual coverage (Medi- Medi)
500
To request or petition that a decision be reexamined.
What is an Appeal
500
comprehensive federal insurance program established by Congress in 1966 that provides financial assistance with medical to ppl 65 yrs. or older & certain disabilities
What is Medicare
500
Failure to exercise a reasonable degree of care
What is Negligence
500
description of amount commonly charged for a particular medical service by providers within a particular geographic region; used for establishing allowable rates.
What is Usual, Customary, and Reasonable (UCR)