The physician’s office sent a request for payment to Able Insurance Company. The term used in the healthcare industry for this request for payment is a(n
What is a claim
100
The AMA publishes the official guidelines & advice.
What is CPT Assistant
100
Patients will pay a percentage of healthcare costs
What is Co-Insurance
100
This Government Sponsored Health Coverage is broken into 4 Parts
What is Medicare
100
It systematically merges clinical, financial & administrative processes to manage access, costs & quality of Healthcare
What is Managed Care
200
The coding system that is used primarily for reporting Durable medical equipment & drugs is known as
What is HCPCS
200
Where are the ICD-9-CM coding guidelines published?
What is Coding Clinic for ICD9-CM
200
Generally paid annually, this cost share is paid 1st... before any benefits are paid by an insurance carrier
What is the deductible
200
Part of the Social Security Act, a joint program between state and federal government to provide healthcare benefits to low income persons and families
What is Medicaid
200
Family Practioners, General Practioners, Internal Medicine aka internists, Pediatricians are Gate Keepers, better known as the PCP
What is Primary Care Physicians
300
In the healthcare industry, what is the term for receiving compensation for healthcare services
What is Reimbursement
300
Required by every HIM Department, 3 main areas include Policies & procedures, Education & Training, and Auditing & Monitoring
What is a Compliance Plan
300
more notably seen by Managed Care Plans, This type of cost share is a set fee paid, for each & every visit
What is a Co-Pay
300
Part C of Medicare is better known as
What is Medicare Advantage
300
The term is used to describe the appropriateness of the setting for the healthcare service in the continuum of care and level of service
What is Utilization Review
400
A type of reimbursement methodology that healthcare insurance companies reimburse providers after the costs have been incurred?
What is Retrospective
400
An office under Department of Health & Human Services. Hot spots for fraud & abuse in healthcare can be found in this areas work plan
What is /Who is The Office if Inspector General
400
the term for the contract between the healthcare insurance company and the individual or group for whom the company is assuming the risk is better known as?
What is policy
400
In Ohio, employers are required to pay into a fund to cover healthcare costs and lost income that results from a work related injury.
What is Workers Compensation
400
Reimbursement method used by MCOs which pays providers one predetermined amount for all the care a patient may receive during a set period.
What is Episode of Care
500
These Services have the highest likelihood of being a “covered service”?
What is Medical Necessity
500
Oversight of Medicare Claim Payments is required by CMS, & these entities work on a contingency basis for CMS to audit & determine if facilities a billing fraudulently.
What is (are ) the RACs Recovery Audit Contractors
500
The difference between what is charged a facility and what is paid by an Insurance Carrier is known as
What is the contractual Adjustment
500
This Coverage under the Department of Defense provides a healthcare program for Active-Duty & retired members of the seven uniformed services of the United Staes
What is Tricare
500
Term used by Contract Management that may select to separate out services or populations of patients to decrease risk and cost