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Finished MA116 ROW 1 Chapters 27 and 30
Medical terminology (chse 120), lansing community college.
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ROW 1 - Chapter 27 Health Insurance Basics
VOCABULARY REVIEW
Using the word pool on the right, find the correct word to match the definition. Write the word on the line after the definition.
INSURANCE TERMINOLOGY A Word Pool
A document sent by the insurance company to the provider and the patient explaining the allowed charge amount, the amount reimbursed for services, and the patient’s financial esponsibilities
An online marketplace where you can compare and buy individual health insurance plans; state health insurance exchanges were established as part of the Affordable Care Act
Low-income Medicare patients who qualify for Medicaid for their secondary insurance _______________________
A formal request for payment from an insurance company for services provided _______________________
System used to determine how much providers should be paid for services rendered; used by Medicare and many other health insurance companies _______________________
An order from a primary care provider for the patient to see a specialist or get certain medical services _______________________
A written agreement between two parties where one party (the insurance company) agrees to pay another party (the patient) if certain specified ci cumstances occur _______________________
A list of fixed fees for services ______________________
An organization that processes claims and provides administrative services for another organization; often used by self-funded plans _______________________
Poor, needy, impoverished _______________________
policy claim indigent resource-based relative value scale (RBRVS) explanation of benefits (EOB) fee schedule qualified Medicare beneficiaries (QMBs) third-party administrator (TPA) health insurance exchange referral
marisa royston 09/14/
Health insurance exchange, fee schedule.
Chapter 27 Health Insurance Basics
INSURANCE TERMINOLOGY B Word Pool
An approved list of physicians, hospitals, and other providers
A decision-making process used by managed care organizations; used to manage healthcare costs through case-by-case assessments of the appropriateness of care _______________________
The primary care provider in charge of a patient’s treatment; additional treatment, such as referrals to a specialist, must be approved by this person _______________________
A service provided by various insurance companies for providers to look up patient insurance benefits, eligibilit , claims status, and explanation of benefits ______________________
A designated person who receives funds from an insurance policy
A process required by some insurance carriers in which the provider obtains permission to perform certain procedures or services _______________________
The amount of time a patient waits for disability insurance to pay after the date of injury _______________________
A payment arrangement for healthcare providers; the provider is paid a set amount for each enrolled person assigned to them, per period of time, whether or not that person has received services
preauthorization gatekeeper provider network capitation utilization management online provider insurance web portal waiting period beneficiary
PROVIDER NETWORK
Ultilization management, online provider insurance web portal, beneficiary, preauthorization, waiting period.
Chapter 30 Billing and Reimbursement
INSURANCE TERMINOLOGY D Word Pool
To settle or determine judicially _______________________
A form completed by the patient that authorizes the medical office to release medical records to the insurance company for health insurance reimbursement _______________________
Nonsurgical procedure that uses an endoscope to view inside the body _______________________
CPT and HCPCS codes (services or supplies) used to treat the patient’s diagnosis (indicated by the ICD code) meet the accepted standard of medical practice _______________________
A process done before claims submission to examine claims for accuracy and completeness _______________________
Software that finds common billing er ors before the claim is sent to the insurance company _______________________
A number assigned by the Centers for Medicare and Medicaid Services (CMS) that classifies the healthca e provider by license and medical specialties _______________________
The provider is paid a set amount for each enrolled person assigned to him or her, per period of time, whether or not that person has received services _______________________
release of information endoscopy capitation audit adjudicate National Provider Identifier claim scrubbers medical necessity
RELEASE OF INFORMATION
Medical necessity, claim scrubbers, national provider identifier.
- Multiple Choice
Course : Medical Terminology (CHSE 120)
University : lansing community college.
- More from: Medical Terminology CHSE 120 Lansing Community College 61 Documents Go to course
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