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Basic Skills
Health Insurance
Histories
Definitions
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100
These skills are necessary in dealing with both patients and insurance companies.
What is Excellent Communication Skills
100
Identification+treatment of disease
What is Medical Care
100
US Congress established three government health care programs in the year of 1965-1966
What is Medicare/Medicaid and CHAMPUS.
100
This is a fixed fee paid at each visit for each service rendered.
What is a Co-pay
100
the method used by HMOs and other managed care plans to pay the health care providers a fixed amount on a per capita (per person) basis.
What is Capitation
200
This requires insurance specialist to be competent in internet usage.
What is Internet Access
200
Medical Care+Preventative services
What is Health Care
200
In the 1990's this insurance was renamed TRICARE.
What is CHAMPUS
200
a specified amount of annual out-of-pocket expenses for covered health care services the insured must pay for health care before the insurer pays benefits.
What is a Deductible
200
developed a procedural coding system to standardize procedural terminology used on insurance claims. The Current Procedural Terminology (CPT) was born.
What is AMA(American Medical Association)
300
This requires careful consideration and thorough follow-up.
What is Attention to Detail
300
A contract between a policy holder and an insurance carrier.
What is Health Insurance
300
In what year did HMO's become popular among employers?
What is 1970
300
the amount a patient pays monthly, quarterly, or yearly that keeps him/her enrolled in the insurance plan and guarantees coverage.
What is a Premium
300
Basic knowledge of anatomy and physiology
What is Basic Skill requirement
400
This is defined as the principle of right or good conduct.
What is Strong sense of Ethics
400
This is defined as reimbursement for income lost as result of temporary or permanent illness or injury.
What is Disability Insurance
400
This limits restrictions for pre-existing conditions, offers tax incentives for the purpose of long-term care insurance, required the adoption of new standards for financial and administrative electronic transmission of claims, new standards for claims attachments, and standardized diagnostic and procedure coding.
What is HIPPA
400
a specified percentage of each fee for a covered service the patient must pay the provider.
What is Coinsurance
400
Insurance specialists must have the ability to take diagnoses, signs/symptoms, and treatments or services and translate them into numerical “codes” which are then reported on all health insurance claim forms.
What is Medical Terminology
500
Federal legislation requires all medicare/Medicaid claims to be submitted electronically.
What is Data Entry Ability
500
This is a policy that covers losses to a third party caused by the insured,owned by the insured, or on premises owned by the insured.
What is Liability Insurance
500
In 1984 Medicare began requiring physicians’ offices to submit these codes.
What is ICD-9
500
a list of pre-established payment amounts for health care services provided to patients.
What is a Fee Schedule
500
Research and prepare appeals for all underpaid, unjustly recoded, or denied claims.
What is Responsibilities