Insurance

Question 1

third party payer

Answer 1

organization other than the pt (1st party) or health care insurance (2nd party) - financing of personal health services

Question 2

insurance

Answer 2

service provided by a third-party that pools the risk and contracts for services with providers

Question 3

risk

Answer 3

associated with health isurance takes into account age, how often health care utilized, incidence of conditions of the population to create a budget and decide on a monthly premium

Question 4

employer-based insurance

Answer 4

healthcare costs rising are affecting employers ability to provide health insurance, employer pays employees insurance

Question 5

premium

Answer 5

amount paid each month, split between employer and employee

Question 6

deductible

Answer 6

how much you have to pay before insurance kicks in

Question 7

co-pay

Answer 7

per service fee

Question 8

co-insurance

Answer 8

percent of insurance

Question 9

four-steps for billing a prescription

Answer 9

1. price of product determined (usual and customary price)
2. claim sent from provider to third party
3. reimbursement promise sent to provider
   4: post-payment reconciliation, audits, direct and indirect renumeration fee assessment