Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

mod 5 > insurance terms MA116, 117 > Flashcards

insurance terms MA116, 117 Flashcards

1
Q

abuse

A

purposely causes harm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

adjudicate

A

to settle or determine judicially

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

advanced beneficiary notice ABN

A

a notice that healthcare facilities send out when the accepted payment is excepted to be denied

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

approved/allowed amount

A

the max your insurance company will pay

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

assignments of benefits

A

an legal agreement that allows a patient healthcare provider to receive payment from the insured party

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

audit

A

a process completed before claims are examined for accuracy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

beneficiary

A

Designated person to receive funds in a life insurance policy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

benefits

A

the 10 categories
included in your essential health care plan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

birthday rule

A

when a child has parents that both have different insurance policy the patrent that birthday falls first in the calendar year becomes the primary insurance and the other becomes the secondary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

capitation

A

a payment arrangement for healthcare providers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

claim

A

term used when filling insurance documents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

clean claim

A

when all information is correct that is filled on the insurance form

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Center for Medicare and Medicaid severs (CMA)

A

federal agency that providers healthcare thur Medicaid, Medicare, and children’s health insurance programs (CHIP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Co-insurance

A

the amount you pay for covered health care after you meet your deductible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Co payment

A

a set dollar amount that is required to pay for each office visit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

The Current Procedural Terminology (CPT)

A

an online coding journal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

deductible

A

the amount the policy holder is required to pay before the insurance company will start to pay

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

demographic

A

personally information about the patient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

direct billing

A

a process where an insurance company allows the provider to electorally submit claims directly to the company

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

effective date

A

when coverage begans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

elective procedure

A

a medical surgical intervention that isnt medically necessary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

eligibility

A

meeting the requirements to participate in the healthcare plan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

encounter form

A

a medical document that records details of a patients visit to a healthcare providers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

exclusion

A

when insurance covered does not apply to certain events

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

explanation of benefits (EBO)

A

to inform the patients with cost for their medical care

26
Q

federal tac ID/ employment identification number (EIN)

A

social security number

27
Q

fee schedule

A

is a single national number to all services that included a conversion factor

28
Q

fraud

A

knowing and willing to execute a scheme

29
Q

group policy

A

when a employer can pick and choose the benefits it wants for their employees

30
Q

primary care physician (PCP)/ gatekeeping

A

a general practice or non specialist provider, that is responsible for the patients care

31
Q

health insurance exchange

A

an individual policy can cover one person or family

32
Q

health maintenance organization (HMO)

A

are health plans that are regulated by HMO laws, which are required them to preventive care as a part of there benefits packages

33
Q

ICD

A

international classification of diseases

34
Q

independent practice association (IPA)

A

a group of independent physician practices that work together to improve efficiency and pursue

35
Q

indigent

A

the elderly, military, and government employees

36
Q

managed care organization (MCO)

A

a healthcare company or plan that manages healthcare services for its members to control cost while maintaining or improving the quality of care

37
Q

Medicaid

A

government insurance meant for low income

38
Q

medicare

A

insurance for people over the age of 65

39
Q

Medicare part a

A

covers inpatients and hospitals chargers

40
Q

medicare part B

A

covers primary care and specialist

41
Q

medcare part c

A

option for people that want to combine parts A and B to have more access to extra benefits

42
Q

medicare part D

A

is a prescription drug program that has their own monthly premium

43
Q

medigap (MG)

A

a policy that can help you pay other healthcare cost

44
Q

non covered services

A

things that arent covered in the insurance plans

45
Q

national provider identifier (NPI)

A

unique identifier given to each healthcare that is used in administrative transactions

46
Q

online insurance web portal

A

where you can verify insurance edibility, benefits, and exclusions prior to the patients appointment

47
Q

out of pocket expense

A

portion require for the patient to pay

48
Q

participating providers

A

providers listed on PPO
(preferred provider organization) that has the accepted providers and healthcare facilities

49
Q

policy

A

a legal contract and will stay in place as long as the premium is being paid

50
Q

precertification/perautorziation

A

a document a provider is required to submit to show that the patient needs the medical producer

51
Q

premium

A

the periodic (monthly, quarterly, or annual) payment for you insurance

52
Q

primary policy

A

the patients primary insurance

53
Q

provider network

A

an approved list of physician’s, hospitals, and other providers

54
Q

provider web portal

A

where all claims are submitted too

55
Q

resources based relative value scale (RBRUS)

A

a system used to determine how much providers should be paid for services rendered

56
Q

referral

A

an order from a pcp for the patient to see a specialist

57
Q

secondary policy

A

the 2nd policy listed on the patients insurance

58
Q

TRICARE

A

an program for active duty and retired military members of uniformed services and their families

59
Q

verification of benefits

A

A process that determines what patients insurance will cover

60
Q

workers compensation

A

is a publicy sponsored program system that pays monetary benefits to workers who become injured or disable in the course of their employment

mod 5 (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions