My #7
Unit 7
Kinn’s The Administrative Medical Assistant, 13th Edition
Chapter 14: Patient Accounts, Collections, and Practice Management
VOCABULARY REVIEW
Fill in the blank with the correct vocabulary terms from this chapter.
An alphanumeric number issued by the insurance company giving approval of a procedure or service is a(n) _________________.
The amount payable by insurance companies for a monetary loss to an individual insured by the company, under each coverage, is known as _________________.
In the United States, Health Care practitioners readers services_________________ receiving payment.
Active duty military personnel, family members of active duty personnel, military retirees and their eligible family members under the age of 65, in the survivors of all uniformed services are covered by_________________.
The health benefits program run by the Department of Veterans Affairs (VA) that helps eligible beneficiaries pay the cost of specific healthcare Services and supplies is the (give acronym) _________________.
_________________ provides periodic payments to replace income when an insured person is unable to work as a result of illness, injury, or disease.
The _________________ __________ is the day on which insurance coverage begins seven benefits are payable.
_________________ is the process of confirming health insurance coverage for the patient for the medical service and the day of service.
The term for limitations on an insurance contract for which benefits are not payable is _________________.
A reimbursement model in which the health plan pays the provider’s fee for every health insurance claim is called_________________.
Medicaid and Medicare are examples of _________________ plans.
A privately sponsored health plan purchased by an employer for their employees is considered a _________________ policy.
_________________ is a third party system that reimburses a provider when services are rendered for an insured patient.
A(n) _________________ is a healthcare plan that controls the cost of healthcare delivery by requiring all patients to seek care with a primary care provider to assess if more specialized care is needed.
_________________ pay for all or a share of the cost of covered services, regardless of which physician, hospital, or other licensed healthcare provider is used. Policy holders of these plans and their dependents choose when and where to get health care services.
A __________________ is health insurance coverage for those who were not covered by their employer group plan.
An umbrella term for all healthcare plans that focus on reducing the cost of delivering quality care to patient members in return for schedule payments and coordinated care through a defined network of primary care physicians and hospitals is ______________________.
A(n) ___________________________ is a healthcare provider who enters into a contract with a specific insurance company or program and agrees to accept the contracted fee schedule.
______________________ is a process required by some insurance carriers in which the provider obtains authorization to perform certain procedures or services or to refer a patient to a specialist.
20. The payment of a specific sum of money to an insurance company for a list of health insurance benefits is called a(n) _______________________________.
21. The primary care provider who can approve or deny when a patient seeks additional care is referred to as a(n) ____________________________.
22. An insurance term used when a primary care provider wants to send a patient to a specialist is ____________________________.
23. The fee schedule designed to provide national uniform payment of Medicare benefits after adjustment to reflect the differences in practice costs across geographic areas is called the____________________________.
24. A(n) ____________________________ is funded by an organization with an employee base large enough to enable it to fund its own insurance program.
25. The intermediary and administrator who coordinates patients and providers and processes claims for self-funded plans is called a(n) ______________________.
26. A government-sponsored program under which authorized dependents of military personnel receive Medical Care was originally called CHAMPUS but now is called____________________________.
27. A(n) ____________________________ is a review of individual cases of a committee to make sure services are medically necessary and to study how providers use medical care resources.
28. ____________________________ is an insurance plan for individuals who are injured on the job either by accident or an acquired illness.
29. Health insurance plans pay for health services deemed____________________________.
30. The ____________________________ was passed in 2010 to assist more Americans in obtaining health insurance.
31. Low and middle-income Americans can purchase health insurance at a(n) ____________________________ to apply for health insurance and not worry about being denied for a pre-existing condition.
32. There are resources for patients who have questions on health insurance coverage through the patient protection and Affordable Care Act, such as ____________________________.
33. Benefits cover the____________________________, or the amount that should be paid to the healthcare provider for services rendered.
34. patients have a higher financial responsibility when they access care that is____________________________.
35. ____________________________ are used by many healthcare facility offices to quickly verify eligibility and benefits.
36. When a provider agrees to become a PAR, they also agreed to the health insurance plan’s ____________________________ for rendered medical services.
37. The ____________________________ is the maximum that third-party payers will pay for a procedure or service.
38. Healthcare providers need to apply to become a____________________________ through a process called credentialing.
39. The resource-based relative value scale includes the following three parts:
A.________________________________________________________________________
B.________________________________________________________________________
C.________________________________________________________________________
40. ____________________________ All type of healthcare organization that contracts with various health care providers and medical facilities at a reduced payment schedule for their insurance numbers.
41. A(n) ____________________________ Usually takes 3 to 10 working days for review and approval. This type of referral is used when the physician believes that the patient must see a specialist to continue treatment.
42. Prescription drugs are covered by Medicare____________________________.
SKILLS AND CONCEPTS
Match the following terms and definitions.
____ Medicaid
____ Medicare
____ Medigap
A federally sponsored health insurance program for those over 65 years or disabled individuals under 65 years
A term sometimes apply to private insurance products that supplement Medicare insurance benefits
A federal and state-sponsored health insurance program for the medically indigent
Read the following paragraph and then fill in the blanks.
The medical assistant tasks related to health insurance processing are initiated when the patient and counters the provider by appointment, as a walk-in, or in the emergency department or hospital. To complete insurance billing and coding properly, the medical assistant must perform the following tasks:
Obtain information from the patient and/or the guarantor, including ______________________and _________________________ data.
Verify the patient’s _______________________ for insurance payment with the insurance carrier or carriers, as well as insurance ________________________, exclusions, and whether _____________________ is required to refer patients to specialists or to perform certain services or procedures, such as surgery or diagnostic tests.
Obtain ____________________ _____________________ for referral of the patient to a specialist or for special services or procedures that require advance permission.
Match the types of insurance benefits with their description.
| _____ Hospitalization |
|
| _____ Surgical | B. Provides reimbursement for all or a percentage of the cost of refraction, lenses and frames |
| _____ Basic medical | C. Helps defray medical costs not covered by Medicare |
| _____ Major medical | D. Provides payment of a specified amount upon the insured’s death |
| _____ Disability | E. Covers a continuum of broad-range maintenance and health services to chronically ill, disabled, or mentally disabled individuals |
| _____ Dental care | F. Pays all or part of a surgeon’s or assistant surgeon’s fees |
| _____ Vision care | G. A form of insurance that insures the beneficiary’s earned income against the risk that a disability will make working uncomfortable or impossible and provides weekly or monthly cash benefits |
| _____ Medicare supplement | H. Pays all or part of a physician’s fee for nonsurgical services, including hospital, home, and office visits |
| _____ Liability insurance | I. Provides protection against especially large medical bills resulting from catastrophic or prolonged illnesses up to a maximum limit, usually after coinsurance and a deductible have been met |
| _____ Life insurance | J. Pays the cost of all or part of the insured person’s hospital room and board and specific hospital services per DRG guidelines |
| _____ Long-term care insurance | K. Often includes benefits for medical expenses related to traumatic injuries and lost wages payable to individuals who are injured in the insured person’s home or in an automobile accident |
