Insurance Fundamentals Flashcards
What type of insurance plans can be offered to patients?
- Government plans
- Private plans
List the government insurance plans offeref to patients?
- Medicare
- Medicaid
- Tricare
- CHAMPVA
Who qualifies for Medicare and what does it entail?
- Patients ocer 65 and older
- Part A (Hospitalization), Part b (medical office visits), Part D (medications)
Who qualifies for Medicaid?
Medically indigent/low income
Who qualifies for Tricare?
Active duty service and family members
Who qualifies for CHAMPVA?
Veterans Affairs
What are the different types of private insurance plans?
- Group
- Individual (Examples: Blue Cross, Humana, Aetna, Cigna)
- Workers compensation
Define Allowed amount
Maximum amount a third-party (insurance) will pay for a procedure or service
Define Copay
A set amount of money that is paid by the patient at the time of service
Define coinsurance
The policyholder and insurance carrier share costs. 80/20
Define Deductible
Amount of money paid out of pocket before insurance carrier begins paying
What is used by healthcare payers to invoice insurance and government plans?
CMS-1500 form
Medical assistants must have all information to complete form
How are insurance claims submitted? (2)
Submitted electronically:
* Direct biling: insurance carriers allow provders to submit directly to insurance company electronically
* Claringhouse: allow providers to submit all insurancee claims, and send them to appropriate insurance company
What is the time limit for Medicare/Medicaid claim invoices?
12 months from service
Claims must be sent timely
