When society tends to be hasty in bringing lawsuits, it is said to be _____________________.
What is litigious.
100
When a health insurance professional intentionally and knowingly misrepresents facts to increase the payment of a claim it is commonly known as__________________.
What is fraud.
100
Health insurance narrows down undesirable events to ___________________.
What are illnesses and injuries.
100
A specific provider who oversees the total healthcare treatment of an individual enrolled in certain managed care plans is a _________________________.
What is primary care physician.
100
A ____________________ provider is one contracts with the insurer, agreeing to abide by certain rules and reglations of that carrier.
What is participating.
200
On the CMS-1500 form, patients information is entered in ___________________.
What is the top of the form.
200
The form that is commonly used today for insurance claims is the __________________.
What is CMS-1500
200
The business of protecting, through legal means, a person or property against loss or harm is referred to as ________________________.
What is insurance.
200
A business entity that receives claims from providers, consolidates them, and sends them on to various third-party payers is called a ____________________.
What is claims clearinghouse.
200
Lnsurance companies are referred to as ______________ payers.
What is third-party.
300
When the health insurance professional extracts certain information from a patient's health record to complete the CMS-1500, it is called ____________________.
What is abstracting.
300
In compliance with HIPAA, when patients visit their healthcare providers for treatments, they are given a/an ________________________.
What is privacy statement.
300
One category that may be exempt from mandatory electronic claim submission is a/an _________________.
What is small provider.
300
A system designed to determine the medical necessity and appropriateness of a requested medical service or procedure is a/an _________________________.
What is utilization review.
300
The earliest and probably best known commercial insurer in this country is ________________________.
What is Blue Cross Blue Shield.
400
Which federal act, passed in 1996, is intended to improve the efficiency of healthcare delivery, reduce administrative cost, and protect patient privacy?
What is HIPAA.
400
Medical illnesses or injuries that a patient has prior to the purchase of a health insurance policy are called ____________________________.
What are preexisting conditions.
400
A clinical, scientific, administrative, and legal document of facts containing statements relating to a patient is a definition of a _____________________________.
What is medical record.
400
A group of healthcare providers working under one umbrella to provide medical services at a discount to the individuals who participate in he plan is referred to as a/an ________________.
What is PPO.
400
A relatively small out-of-pocket dollar amount that a member of a managed care plan typically pays op front is ______________________.
What is a copayment.
500
The traditional kind of health insurance wherein patients can choose any provider or hospital they wish and change physicians at will is __________________________.
What are indemnity and fee-for-service
500
The federal act that sets minimum standards for pension plans for private industry is ____________________.
What is ERISA
500
The following rules and conventions governing correct or polite behavior in society is called ________________.
What is etiquette.
500
The amount of money an individual pays in return for health insurance coverage is called a/an _________________.
What is premium.
500
The federal act that allows employees who quit their jobs or get laid off to extend their group coverage is known by the acronym ________________________.