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CMA > INSURANCE TERMS > Flashcards

INSURANCE TERMS Flashcards

1
Q

private insurance

A

provided by persons employer

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2
Q

Primary Insurance

A

insurance that’s filed first and is the main insurance for a person

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3
Q

premium

A

the amount of money that a person pays for their insurance

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4
Q

secondary insurance

A

durable coverage, can pay unpaid balances

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5
Q

birthday rule

A

the plan of the parent with the first birthday in the calendar year is the primary insurance

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6
Q

self insured

A

individual pays for their insurance (usually self-employed

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7
Q

Self-Pay

A

people who have no coverage

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8
Q

government plans

A

special programs by state and federal government that provides insurance for the elderly, indigent, and children

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9
Q

co pay

A

a specified sum of money based on the pt insurance policy benefits use at the time of service

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10
Q

deductible

A

specific amount of money a pt must pay out of pocked before insurance carrier begins paying for services

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11
Q

EOB

A

proved to the pt by insurance company as a statement (bank statement)

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12
Q

Co-insurance

A

percentage of the total cost that an individual must contribute toward each service (90%,10%,80%,20%)

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13
Q

RA

A

an EOB sent to the provider from insurance carrier (contains multiple pt and providers)

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14
Q

ABN

A

form that a Medicare pt will sign whenthe provider thinks medicare wont pay for specific service/item

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15
Q

medicare

A

pt 65 and older for part a (hospitalization) part b (routine office visits), part d (prescription coverage)

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16
Q

tricare

A

authorizes dependents of military personnel to see civilian practictioners

17
Q

CHAMPVA

A

covers surviving spouses and depended children of veteranswho died in service-related disabilities

18
Q

Medicaid

A

health insurance to the medically indigent population through a cost sharing program between federal government and states (children and child baring age)

19
Q

Workers compensation

A

a lesislative law that protects employees against the cost of medical care resulting from work related injury

20
Q

CHIP

A

offers low cost health coverage for children from birth through age 19. designed for families who make too much to qualify for Medicare but cannot afford private health coverage

21
Q

government plans

A

medicare, Medicaid, tricare, CHAMPVA

22
Q

group policies

A

offered through individuals employer who will usually pay a portion of premium from employees pay

23
Q

individual policies

A

insurance plans that an individual funds themselves

24
Q

HMO

A

type of insurance plan that limits coverage of care from doctors who work for or contract with the HMO (referral needed)

25
Q

PPO

A

medical care arrangement in which medical professionals and facilities provide services to subscribed at reduced rates

26
Q

HSA

A

savings account that can be used to pay for medical expenses

27
Q

FSA

A

funded with pretax dollars, does not roll over onto the next year funds(funds lost if not used)

28
Q

ICD-10-CM

A

allows more specific reporting of diseases and newly recognized conditions
allows for specificity and laterality of coding for payment

29
Q

CMS-1500

A

claim form that is sent to the insurance company for review and payment

30
Q

referrals

A

document or form required by insurance companies that is used when a provider wants to send a pt to a specialist

31
Q

participating provider

A

the provider and the insurance company have agreed between the amounts charged and approved and what will and will not be reimbursed

32
Q

account balance

A

total amount owed on an account

33
Q

debt

A

an amount owed

34
Q

accounts recievable

A

moneu owed to the provider

35
Q

accounts payable

A

debts incurred and not yet paid

36
Q

credit

A

monetary balance in an individuals favor

37
Q

assets

A

entire saleable property of a person, association, corporation or estate applicable or subject to the payment

38
Q

Liabilities

A

amounts owed; debt

CMA (2 decks)

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