Comprehensive Final Flashcards
What is a deductible?
The dollar amount that must be paid by the patient before the insurance pays.
What is the difference between a co-pay and a co-insurance?
The co-pay is the set dollar amount.
The co-insurance is the percentage amount paid by the patient.
What does COB stand for?
Coordination of benefits.
What are some characteristics of a PPO?
They have fewer restrictions, never stuck without coverage, they have the option of pre approved providers, they have high premiums and high co-pays.
What are some characteristics of an HMO?
PCP, stay in network, you need prior approval for services, low premiums.
What is a remittance advisory?
Is the Statement sent by insurance company detailing claims submitted.
What is the difference between an actual charge and an allowed charge?
The amount to be build the provider, that amount is what insurance companies will allow the doctor to be paid.
What is Medicare part A?
Inpatient.
What is Medicare part B?
Outpatient.
What is Medicare part C?
Advantage plan.
What is Medicare part D?
Drugs.
What percentage does Medicare pay for and what percentage is the patient responsible for?
80/20%
What does SOF stand for?
Signature on file.
What does ABN stand for and what is its purpose?
Advance Beneficiary Notice; it gives advance warning to patients that services are not covered by Medicare.
What is the name of the standard billing claim form for all outpatient services?
CMS1500.
