Insurance

Question 1

Insurance coverage for families, children, individuals who are pregnant, older adults who have limited income or access to other health insurance coverage, and those who have certain specified medical needs. Funded by federal and state governments and administered by states.

Answer 1

Medicaid

Question 2

Insurance coverage in addition to primary and secondary. Covers gaps in primary and secondary insurance coverage

Answer 2

Tertiary insurance

Question 3

The amount that must be paid before benefits are paid by the insurance

Answer 3

Deductible

Question 4

Which part of medicare covers pharmaceutical drugs

Answer 4

Medicare part D

Question 5

When a dependent has more than one health insurance plan, the plan of the parent/guardian whose birthday month and day come first in the calendar year is determined to be the primary plan

Answer 5

Birthday rule

Question 6

what should be verified if the patient is covered by more than one health plan?

It refers to the sequencing of plans when a patient has more than one insurance plan and it’s necessary to determine which is primary and which is secondary.

Answer 6

Coordination of benefits (COB)

Question 7

The percentage of the allowed amount the patient will pay once the deductible is met

Answer 7

Coinsurance

Question 8

A set amount determined by the plan/payer that the patient pays for specified services, usually office visits and emergency department visits

Answer 8

Copayment

Question 9

A request to determine if a service is covered by the patient’s policy

Answer 9

Precertification

Question 10

Which part of medicare covers outpatient and professional coverage?

Answer 10

Medicare part B

Question 11

The amount paid or to be paid the policyholder for the coverage under the contract, usually in periodic installments

Answer 11

Premium

Question 12

This form is signed by the patient to allow third-party payers to be billed by the medical provider and direct payment made to the medical provider

Answer 12

Assignment of benefits (AOB)

Question 13

An insurance plan in which a provider signs a contract to participate. The provider agrees to accept a discounted rate for procedures

Answer 13

In-network

Question 14

The insurance plan that is billed after the primary insurance plan has paid its contracted amount

Answer 14

Secondary insurance

Question 15

A provision in group health insurance that prevents multiple insurers from paying benefits covered by other policies

Also specifies that coverage will be provided in a specific sequence when more than one policy covers the claim

Answer 15

Coordination of benefits (COB)

Question 16

a network of physicians, other healthcare practitioners, and hospitals that have joined together to contract with insurance companies, employers, or other organizations to provide health care to subscribers for a discounted fee.

Answer 16

Preferred provider organization (PPO)

Question 17

A person who signs a contract with a health insurance company and who owns the health insurance policy

Answer 17

Policyholder

Question 18

The insurance plan responsible for paying health care insurance claims

Answer 18

Primary insurance

Question 19

Which part of medicare covers hospital coverage

Answer 19

Medicare part A

Question 20

A medical insurance group that provides coverage of health care services for a period of time and a fixed annual fee

Answer 20

Health maintenance organization (HMO)

Question 21

This form provides the same information in an electronic format. It usually refers to the provider version as a detailed description of claims payments

Answer 21

Electronic remittance advice (ERA)

Question 22

Sometimes required by the patient’s insurance company to determine medical necessity for the proposed services

Answer 22

Preauthorization

Question 23

This insurance serves the military and their qualifying family members, referred to as dependents.

This includes active duty, retired personnel, dependent/spouses, and dependents of service personnel who died while on active duty.

It provides comprehensive coverage for facility costs, outpatient services, professional medical services, and medication costs.

Answer 23

TRICARE

Question 24

This form shows the claim adjudication as well as the results.

This can include denials, billed amounts, allowed amounts, covered services, and patient financial responsibilities of deductible and coinsurance.

Answer 24

Explanation of benefits (EOB)

Question 25

This is used when medicare may not consider tests, procedures, or services to be medically necessary, and the patient must sign this form after they are informed of this and agree (or disagree) to be financially responsible in the event medicare determines that the service is not medically necessary.

Answer 25

Advanced beneficiary notice (ABN)

Question 26

Which part of medicare covers managed care plans?

Answer 26

Medicare part C

Question 27

Medicare supplemental health insurance for medicare beneficiaries, which may include payment of medicare deductibles, coinsurance, balance bills, or other services not covered by medicare.

Answer 27

Medigap, medi medi

Question 28

insurance provided by the federal government for people aged 65 and up, people with certain disabilities, and people with end-stage renal disease.

Answer 28

Medicare