Show:
Intro to Reimbursement
Clinical Coding & Compliance
Commercial Insurance
Government Insurance
Managed Care
100
In the healthcare industry, what is the term for receiving compensation for healthcare services that were previously provided?
What is Reimbursement
100
Where are the Additional guidance & advice found for CPT? What about ICD10-CM & PCS
What is CPT Assistant, what is ICD10-Coding Clinic
100
In the healthcare industry, what is the term for the written report that insurers use to notify insureds about the extent of payments made on a claim?
What is an EOB - Explanation of Benefits
100
CMS is better known as
What is Center for Medicare and Medicaid Services
100
what type of care should the physician practice manager expect to work with a case manager?
What is Workers Compensation
200
What factor is health insurance status most closely linked?
What is Employment
200
What law mandates EDI & the use of Code sets
What is HIPAA
200
In the healthcare sector, when a patient’s healthcare services are covered under a voluntary health care insurance plan, the person who pays the remainder of a healthcare bill, after the healthcare insurance company has paid, is called the ?
What is Guarantor
200
Medicare supplement insurance or Medicare supplemental insurance - refers to various private health insurance plans sold to supplement Medicare in the United States
What is Medigap
200
Medicare part C is a ___________ option known as Medicare Advantage
What is Medicare Advantage
300
In which type of reimbursement methodology do health care insurance companies determine payment to providers before the services have been delivered? what is payment meth is after service is provided?
What is a Prospective, What is Retrospective
300
The Abbreviation - OIG - It is area of the US Government that which keeps a watchful eye on Fraud and Abuse ~ it's publishes a yearly work plan for Compliance Managers
What is Office of Inspector General
300
Experimental therapeutic procedures, Medically unnecessary diagnostic procedures & Cosmetic procedures are all considered typical _____?
What are exclusions
300
Inpatient hospital services, skilled nursing facilities, Hospice coverage under Medicare Part?
What is Medicare Part A
300
What is the term that means evaluating, for a healthcare service, the appropriateness of its setting and its level of service
What is Utilization Review
400
The payment method known as per diem is also known as
What is per day
400
The submission of unintentionally inaccurate charges on a claim for reimbursement is better known as? what is the deliberate submission of a bogus claim for money?
What is abuse? What is fraud?
400
In the healthcare sector, what is the term for the fixed dollar amount that the guarantor pays? what is the annual dollar amount known as? What is the percentage known as?
What is a copayment What is a deductible What is a co-insurance
400
Which Medicare Part is associated with the Medicare Modernization Act of 2003 (MMA) created an outpatient prescription drug benefit
What is Medicare D
400
Jane Doe belongs to a managed care plan. She wants to make an appointment with an out-of-network specialist. The plan has approved the appointment as “out-of-network.” What should she expect?
What is except to pay an increase to out-of-pocket costs
500
Capitated Payment, Global Payment & Prospective Payment Method all fall under an umbrella term better known as
What is Episode of Care
500
The bill that the pathologist’s office submitted for a laboratory test was $32.00. In its payment notice (remittance advice), the healthcare plan lists its payment for the laboratory test as $28.00. What does the amount of $32.00 represent?
What is the allowable fee
500
Benefit caps, Cost-sharing provisions, and the use of formularies for prescription drugs are considered?
What are types of limitations
500
Also known as a waiver of liability, is a notice a provider should give you before you receive a service if, based on Medicare coverage rules, your provider has reason to believe Medicare will not pay for the service.
What is an ABN - An Advance Beneficiary Notice
500
A type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. You pay less if you use providers that belong to the plan's network.
What is PPO - Preferred Provider Organization