Midterm Part 3 Flashcards
The patient must pay $500 out of her own pocket before her insurance company will begin to reimburse for medical expenses. She is also responsible fo 20% of the bill for medical services. The $500 is a __________.
A. Deductible
B. Coinsurance
C. Co-pay
D. Premium
Deductible
Mrs. Jones, a Medicare patient with a Medigap insurance policy, is seen for an office visit and the fee is $90. The Medicare approved amount is $62.99. The Patient has met her deductible for the year. What would be the Medicare payment?
A. $50.39
B. $12.60
C. $72
D. $62.99
$50.39
Which of the following is NOT covered by Medicare Part A?
A. Inpatient hospital care
B. Hospice care
C. Home health care
D. Outpatient ambulatory care
Outpatient ambulatory care
Mrs. Jones, a Medicare patient with a Medigap insurance policy, is seen for an office visit and the fee is $90. The Medicare approved amount is $62.99. The Patient has met her deductible for the year. What would be the Medigap payment?
A. $12.60
B. $62.99
C. $50.39
D. $18
$12.60
The Physician’s office sent a request for payment to Able insurance company. The term used in the healthcare industry for this request for payment is _________.
A. An allowance
B. Reimbursement
C. A block grant
D.A claim
A claim
Which consumer-directed health plan provides tax-exempt accounts offered by employers to any number of employees, which individuals use to pay health care bills? the employees contribute funds through a salary reduction agreement and withdraw funds to pay medical bills. Funds are exempt from both income tax and social security tax (and employers may also contribute). By law, employees forfeit unspent funds at the end of the year.
A. Health reimbursement arrangement
B. Flexible spending account
C. Health Savings account
D. Customized sub-capitation plan
Flexible spending account
In its payment notice, the healthcare plan lists that the payment for the individual laboratory test $39.00. The bill that the pathologist’s office submitted for the laboratory test was $45.00. What does that amount of $39.00 represent?
A. Captivated rate
B. Premium
C. Cost
D. Allowable fee
Allowable fee
The term used to refer to the statement sent to the provider and the patient to clarify the services provided, billed amounts, and payment made by the payer.
A. Electronic data interchange
B. Claims transaction
C. Explanation of benefits
Explanation of benefits
Which party sign a contract with a health insurance company and thus, owns the health insurance policy?
A. Dependent
B. Patient
C. Policyholder
D. Payer
Policyholder
In Medicare medical necessity denial is a denial of otherwise covered services that were found to be not ________.
A. In compliance with critical pathways
B. Reasonable and necessary
C. Necessary and Frequent
D. Cost effective and necessary
Reasonable and necessary
