Final Insurance Billing & Coding Flashcards
A fixed percentage of covered charges paid by the insured person after deductible has been meet
Coinsurance
A list of charges for services or procedures performed is
Fee scheduled
A managed care program in which its members are expected to receive treatment from one of its participants providers
HMO
A provider who participates in an insurance carriers plan is considered to be:
PAR
An explanation of benefits (EOB) is called a (n)
RA (remittance advice)
Assignment of benefits-completed with these providers to ensure payments directly from the insurer to the provider
A PAR
Coordination of benefits refers 
The legality of having more than one insurance policy
Elderly/disabled patient who qualify for Medicare cannot pay for Medicare charges and qualify for dual coverage
Medi/Medi
Electronic Claims sent directly to insurance plan or a __________where the claim information will be scrubbed clean
Clearinghouse
Eligibility for this health program may vary as qualification is dependent on the individual monthly income
Medicaid
If a claim is submitted electronically, the remittance advice
Will be received electronically
In the case of Medi/Madi coverage, which health plan acts as the primary payer
Medicare
Medicare part A pays what portion of her hospitalization for the first 60 days
100%
Medicare is divided into two main part
A and B
Medicare part B has a patient coinsurance responsibility of
20%
Most of the demographic information present on a claim form is entered
Before or at time of appointment
The CPT manual contains diagnostic codes
False
The ICD – 10 contains which two main sections:
Alphabetic index and tabular index
The activity of comparing the physician fees with the benefits provided by the patient’s health plan is
Review of allowable benefits
The insurance policy holder is also referred to as:
Subscriber
The physician’s diagnosis is coded for claim purpose using ICD – 10 – CM
True
There are two major types of health plans
MCO and fee of service
Program standardize claim information and “scrub” and “clean” claim information before treatment
Clearinghouse
This managed care organization requires preauthorization from a PCP who acts as a gatekeeper
HMO
Health care reform in the US was enacted in 2010 its focus was make affordable healthcare accessible to more Americans
ACA
This section of procedure codes is often considered the most important due to their frequent
E/M
Those who are eligible for Social Security benefits are automatically enrolled in which health benefit program
Medicare
When preparing paper claims, it is important to use which claim form
CMS-1500
Which government health plan is designated for active and retired military person
None of the above (TRICARE)
Healthcare program providers coverage for veterans with total permanent service related disabilities
CHAMPVA
Which of the following is considered the third-party payer
The health plan
Which of the following is NOT an example of government insurance plan
Blue cross blue shield
Eligibility is determined by the patient’s nearest veteran affairs (VA) facility
CHAMPVA
Is a healthcare program designed for low-income individuals and children
Medicaid
